Organization
INTEGRATED DERMATOLOGY OF BOISE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN J LUCHETTI MD (AUTHORIZED GROUP OFFICIAL)
(208) 900-3376
Entity
Organization
Contact information
Practice address
3277 E LOUISE DR STE 360, MERIDIAN, ID 83642-9359
(208) 900-3376
(986) 210-1370
Mailing address
4700 EXCHANGE CT STE 110, BOCA RATON, FL 33431-4450
(561) 314-2000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
05/10/2022
Last updated
12/05/2022
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