Individual
ROD D KACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
706 N COLLEGE RD STE C, TWIN FALLS, ID 83301-5824
(208) 735-1000
(208) 732-5345
Mailing address
706 N COLLEGE RD STE C, TWIN FALLS, ID 83301-5824
(208) 735-1000
(208) 732-5345
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M6895
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805168100
—
ID
Enumeration date
01/25/2007
Last updated
02/06/2012
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