Basic Information
| Provider Information | |||||||||
| NPI: | 1700948163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLANNERY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46619 LEIGHTON RD | ||||||||
| Address2: | |||||||||
| City: | RONAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598648930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066763566 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6 13TH AVE E | ||||||||
| Address2: | |||||||||
| City: | POLSON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598605315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068838281 | ||||||||
| FaxNumber: | 4068838910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 6270 | MT | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0147203 | 05 | MT | MEDICAID |