Individual
DEREK KOHLHASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10717 W STATE ST, STAR, ID 83669-6046
(208) 302-6300
(208) 302-6355
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642-1026
(208) 302-9342
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-15600
ID
207Q00000X
Family Medicine Physician
MRM-1814
ID
Other
Enumeration date
05/01/2019
Last updated
07/21/2022
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