Individual
ANANT WADHWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
125 E IDAHO ST STE 300, BOISE, ID 83712-6256
(208) 381-7335
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
2014014255
MO
2084N0400X
Neurology Physician
Primary
M-14935
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014014255
MISSOURI TEMPORARY LICENSE NUMBER
MO
Enumeration date
06/23/2014
Last updated
06/15/2023
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