NPI 1215981410

Mark E Kieckbusch, MD

Practitioner Anatomic Pathology & Clinical Pathology Physician Boise, ID

Practice location

Address: 190 E Bannock St, Boise, ID 83712-6241
Phone: (208) 381-2367
Fax: (208) 381-4762
Mailing address: PO Box 9589, Boise, ID 83707-4589

Registered specialties (2)

Anatomic Pathology & Clinical Pathology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207ZP0102X Licence M6070 (ID)

Other Pathology providers in Idaho →

Hematology (Pathology) Physician

Allopathic & Osteopathic Physicians Taxonomy 207ZH0000X Licence M6070 (ID)

Registry record

NPI: 1215981410
Entity type: Individual
Sex (as registered): Male
NPI issued: 20 May 2006
Record last updated: 11 Dec 2007

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.