Organization
KURT E KRACAW MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KURT EDWIN KRACAW MD (OWNER)
(775) 772-4208
Entity
Organization
Contact information
Practice address
426 FARNSWORTH WAY STE 1, RIGBY, ID 83442-4713
(208) 745-9411
(208) 745-9910
Mailing address
PO BOX 3208, IDAHO FALLS, ID 83403-3208
(208) 523-4906
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-13115
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285723460
TYPE 1 NPI
—
Enumeration date
10/17/2017
Last updated
04/03/2018
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