Provider Demographics
NPI:1053019109
Name:STILLWATER SURGICAL PLLC
Entity type:Organization
Organization Name:STILLWATER SURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHALSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-577-2346
Mailing Address - Street 1:203 ENTERPRISE BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-577-2346
Mailing Address - Fax:
Practice Address - Street 1:203 ENTERPRISE BLVD.
Practice Address - Street 2:SUITE 102
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5971
Practice Address - Country:US
Practice Address - Phone:406-577-2346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty