Provider Demographics
NPI:1184744088
Name:THEIN, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:THEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:DAVID
Other - Last Name:THEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1620 REGENT ST STE A
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5665
Mailing Address - Country:US
Mailing Address - Phone:406-830-3294
Mailing Address - Fax:406-258-0367
Practice Address - Street 1:1048 BURLINGTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5684
Practice Address - Country:US
Practice Address - Phone:406-830-3294
Practice Address - Fax:408-258-0367
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT611352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORF55837Medicare UPIN