Provider Demographics
NPI:1942863246
Name:GLAUS, KELLEE ROSE (MD)
Entity Type:Individual
Prefix:
First Name:KELLEE
Middle Name:ROSE
Last Name:GLAUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3571
Mailing Address - Country:US
Mailing Address - Phone:406-496-3600
Mailing Address - Fax:406-206-1971
Practice Address - Street 1:3636 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3571
Practice Address - Country:US
Practice Address - Phone:406-496-3600
Practice Address - Fax:406-206-1971
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-108810207Q00000X
MT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program