Provider Demographics
NPI:1871695320
Name:TREPTOW, CRAIG L (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:L
Last Name:TREPTOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 15TH AVE S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-727-2121
Mailing Address - Fax:406-727-3910
Practice Address - Street 1:401 15TH AVE S
Practice Address - Street 2:SUITE 201
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4334
Practice Address - Country:US
Practice Address - Phone:406-727-2121
Practice Address - Fax:406-727-3910
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0037791Medicaid
MT0000912120OtherBC/BS NUMBER
MT011000296Medicare PIN
MT0037791Medicaid