Individual
JACOB TISEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3400 LARAMIE DR, BOZEMAN, MT 59718-2005
(406) 587-0122
(844) 656-2480
Mailing address
3400 LARAMIE DR, BOZEMAN, MT 59718-2005
(406) 587-0122
(844) 656-2480
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.006640RX
OH
Other
Enumeration date
08/12/2020
Last updated
12/24/2025
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