Provider Demographics
NPI:1942306063
Name:MIHALICK, TRENT DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:DONALD
Last Name:MIHALICK
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 1:1315 GOLDEN VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6746
Mailing Address - Country:US
Mailing Address - Phone:406-238-6290
Mailing Address - Fax:406-238-6280
Practice Address - Street 1:1315 GOLDEN VALLEY CIR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-238-6290
Practice Address - Fax:406-238-6280
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY259552085R0001X
MT74352085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAB6134OtherBLUE CROSS
KY0089335Medicaid
ID77095OtherBLUE CROSS
ID807866400Medicaid
WA8496622Medicaid
WAB6135OtherBLUE CROSS
KY0089335Medicaid
ID1100107Medicare PIN