Individual
DR. KATHLEEN R. SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1075 N. CURTIS RD, SUITE 200, BOISE, ID 83706-1300
(208) 367-8333
(208) 367-2003
Mailing address
3340 EAST GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
M-7074
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010002158
BLUE SHIELD
ID
05
—
001852402
—
ID
01
—
1134802
CIGNA MEDICARE
ID
01
—
45948
BLUE CROSS
ID
01
—
P00067562
RR MEDICARE
ID
Enumeration date
02/02/2007
Last updated
12/01/2009
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