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OLEG SERGEEVICH KOUSKOV

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2347 E GALA ST, MERIDIAN, ID 83642-4881
(208) 323-3767
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222

Taxonomy

Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
M11223
ID
207RP1001X
Pulmonary Disease Physician
Primary
M11223
ID

Other

Enumeration date
05/23/2007
Last updated
01/23/2014
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