Individual
MR. MICHAEL KENNETH WUCINICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
775 POLE LINE RD W STE 302, TWIN FALLS, ID 83301-5823
(208) 814-8725
Mailing address
3724 E 3770 N, KIMBERLY, ID 83341-5524
(208) 420-8188
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1274
ID
Other
Enumeration date
08/28/2015
Last updated
11/19/2015
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