Provider Demographics
NPI:1053761007
Name:HIPOLITO, RUBEN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:MICHAEL
Last Name:HIPOLITO
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 1:70 VILLAGE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2793
Mailing Address - Country:US
Mailing Address - Phone:406-752-8877
Mailing Address - Fax:406-756-3245
Practice Address - Street 1:70 VILLAGE LOOP RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-8877
Practice Address - Fax:406-756-3245
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT76877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program