NPI 1144887050

St Michael Nephrology, PLLC

Organisation Nephrology Physician Boise, ID

Practice location

Address: 1674 S Loggers Pond Pl APT 14, Boise, ID 83706-7517
Phone: (986) 200-8202
Fax: (626) 593-4751
Mailing address: 999 W Main St STE 100, Boise, ID 83702-9001

Authorised official

Name: Ernest Daniel Moreno Dytiapco
Title: Nephrologist
Phone: (986) 200-8202

Registered specialties

Nephrology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207RN0300X

Other Internal Medicine providers in Idaho →

Registry record

NPI: 1144887050
Entity type: Organization
NPI issued: 26 May 2019
Record last updated: 14 Jul 2019

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.