Provider Demographics
NPI:1942526173
Name:JOUTOVSKY, MIKHAIL (DO)
Entity Type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:JOUTOVSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 HARRISON AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4801
Mailing Address - Country:US
Mailing Address - Phone:406-299-2944
Mailing Address - Fax:406-299-2944
Practice Address - Street 1:1341 HARRISON AVE STE 15
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4801
Practice Address - Country:US
Practice Address - Phone:406-299-2944
Practice Address - Fax:406-299-2944
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT40557207QA0401X, 2084A0401X
NY254695208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery