Provider Demographics
NPI:1497825178
Name:BERKRAM, KELLY KRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:KRISTINE
Last Name:BERKRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:28 VILLAGE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2793
Mailing Address - Country:US
Mailing Address - Phone:406-571-3909
Mailing Address - Fax:406-285-8088
Practice Address - Street 1:28 VILLAGE LOOP RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2793
Practice Address - Country:US
Practice Address - Phone:406-571-3909
Practice Address - Fax:406-285-8088
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11770207Q00000X
MT11740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1497825178Medicaid
MT1497825178OtherBCBS
M011000274Medicare PIN