Individual
KELLY MCGRATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 CEDAR ST, OROFINO, ID 83544-9029
(208) 476-4555
(208) 476-5385
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 476-5777
(208) 476-5385
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6320
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003833500
—
ID
01
—
F25998
UPIN #
ID
Enumeration date
06/14/2005
Last updated
08/06/2021
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