Provider Demographics
NPI:1982618112
Name:BIELIGK, SAMUEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:C
Last Name:BIELIGK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2424
Mailing Address - Country:US
Mailing Address - Phone:208-750-7464
Mailing Address - Fax:208-750-7467
Practice Address - Street 1:415 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-743-7612
Practice Address - Fax:208-746-4802
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD57659208600000X
MO20080102152086X0206X
IDMC-2661208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205492804Medicaid
OK200135770AMedicaid
MOP00785793OtherRAIL ROAD MEDICARE
IDMC-2661OtherIDAHO LICENSE
MOP00785793OtherRAIL ROAD MEDICARE