Provider Demographics
NPI:1356864748
Name:POLIAKIWSKI, KRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:POLIAKIWSKI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 10TH AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2619
Mailing Address - Country:US
Mailing Address - Phone:406-866-0350
Mailing Address - Fax:406-403-0263
Practice Address - Street 1:1500 10TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2619
Practice Address - Country:US
Practice Address - Phone:406-866-0350
Practice Address - Fax:406-403-0263
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1077042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12083Medicaid