Individual
DR. KENNETH JOHN WAKEFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3731 N RAMSEY RD, SUITE 150, COEUR D ALENE, ID 83815-9000
(208) 665-1552
(208) 665-1558
Mailing address
4304 N 16TH ST, COEUR D ALENE, ID 83815-9414
(208) 664-3576
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
M-9596
ID
Other
Enumeration date
09/22/2005
Last updated
02/13/2008
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