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Individual

KATHLEEN M ROMITO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3673 STONE CREEK WAY, BOISE, ID 83703
(208) 861-3673
(208) 367-9204
Mailing address
3673 STONE CREEK WY, BOISE, ID 83703
(208) 861-3673
(208) 367-9204

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M 7149
ID
207Q00000X
Family Medicine Physician
M7149
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002616900
ID
05
1619919933
ID
Enumeration date
06/12/2006
Last updated
08/07/2014
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