NPI 1063719292

St Clair Specialty Physicians

Organisation Nephrology Physician Boise, ID

Practice location

Address: 5610 Gage Street Suite a, Boise, ID 83706
Phone: (208) 367-3370
Mailing address: 45640 Schoenherr Road, Shelby Twp, MI 48315

Authorised official

Name: Robert Provenzano
Title: President/Partner
Phone: (313) 886-8787

Registered specialties

Nephrology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207RN0300X

Other Internal Medicine providers in Idaho →

Registry record

NPI: 1063719292
Entity type: Organization
NPI issued: 24 Feb 2011
Record last updated: 24 Feb 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.