Individual
DR. WALTER KURT BIRKENHAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 S 11TH AVE, POCATELLO, ID 83201-4835
(208) 232-7434
(208) 233-6446
Mailing address
500 S 11TH AVE, POCATELLO, ID 83201-4835
(208) 232-7434
(208) 233-6446
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M3705
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002370100
—
ID
Enumeration date
08/29/2005
Last updated
03/04/2013
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