Basic Information
| Provider Information | |||||||||
| NPI: | 1154716876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRAKULICH | ||||||||
| FirstName: | DIONNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2835 FORT MISSOULA RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598047424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063274640 | ||||||||
| FaxNumber: | 5049881846 | ||||||||
| Practice Location | |||||||||
| Address1: | 2835 FORT MISSOULA RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598047424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063274640 | ||||||||
| FaxNumber: | 5049881846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MED-PHYS-LIC-77008 | MT | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 77008 | MT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.