Provider Demographics
NPI:1427084060
Name:CREWS, KIRK L (MD)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:L
Last Name:CREWS
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 1:401 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870
Mailing Address - Country:US
Mailing Address - Phone:406-777-7251
Mailing Address - Fax:406-777-7127
Practice Address - Street 1:401 MAIN STREET
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870
Practice Address - Country:US
Practice Address - Phone:406-777-7251
Practice Address - Fax:406-777-7127
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0081889Medicaid
MTG81394Medicare UPIN
MT000084174Medicare PIN