Provider Demographics
NPI:1316999824
Name:ZACHARISEN, MICHAEL C (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:ZACHARISEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4265 FALLON ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6797
Mailing Address - Country:US
Mailing Address - Phone:406-451-7017
Mailing Address - Fax:406-451-7020
Practice Address - Street 1:4265 FALLON ST STE 3A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6797
Practice Address - Country:US
Practice Address - Phone:406-451-7017
Practice Address - Fax:406-451-7020
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT12449207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology