Organization
COEUR D'ALENE SURGICAL AND VEIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN M JOHNSON M.D. (MANAGING MEMBER)
(208) 664-4940
Entity
Organization
Contact information
Practice address
608 NORTHWEST BLVD, SUITE 301, COEUR D ALENE, ID 83814-2174
(208) 664-4940
(208) 664-5345
Mailing address
608 NORTHWEST BLVD, SUITE 301, COEUR D ALENE, ID 83814-2174
(208) 664-4940
(208) 664-5345
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
M-7963
ID
Other
Enumeration date
01/06/2010
Last updated
03/20/2013
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