Provider Demographics
NPI:1760709661
Name:HARADA, KEVIN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ARTHUR
Last Name:HARADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-1231
Mailing Address - Country:US
Mailing Address - Phone:406-265-7831
Mailing Address - Fax:406-262-1636
Practice Address - Street 1:20 13TH ST W
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5215
Practice Address - Country:US
Practice Address - Phone:406-265-7831
Practice Address - Fax:406-262-1636
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT925570OtherBLUE CROSS BLUE SHIELD
MT1760709661Medicaid
MTM011003841Medicare PIN