Organization
IDAHO KIDNEY INSTITUTE LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAHIM RAHIM M.D. (PRESIDENT)
(208) 904-4780
Entity
Organization
Contact information
Practice address
4511 ZEBE AVE, CHUBBUCK, ID 83202-4707
(208) 904-4780
(208) 904-4832
Mailing address
PO BOX 268934, OKLAHOMA CITY, OK 73126-8934
(208) 904-4780
(208) 904-4832
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807177400
—
ID
Enumeration date
01/04/2007
Last updated
04/08/2021
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