Provider Demographics
NPI:1801909080
Name:ZILKOSKI, MARK W (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:ZILKOSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-1826
Mailing Address - Country:US
Mailing Address - Phone:406-653-2150
Mailing Address - Fax:406-653-6591
Practice Address - Street 1:301 KNAPP ST
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1826
Practice Address - Country:US
Practice Address - Phone:406-653-2150
Practice Address - Fax:406-653-6591
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT4533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0096265Medicaid
MT14670OtherBCBS OF MT
WA0198430OtherDEPT L&I
MT0096265Medicaid