Organization
IDAHO UROLOGIC INSTITUTE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD WALDAMANN M.D. (MANAGER)
(208) 343-7736
Entity
Organization
Contact information
Practice address
2855 E MAGIC VIEW DR, MERIDIAN, ID 83642-6245
(208) 639-4900
(208) 639-4939
Mailing address
2855 E MAGIC VIEW DR, MERIDIAN, ID 83642-6245
(208) 639-4900
(208) 639-4939
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006729
BLUE SHIELD MERIDIAN
ID
01
—
000010152026
BLUE SHIELD NAMPA
ID
05
—
807277400
—
ID
01
—
8M152
BLUE CROSS BOISE
ID
01
—
8M783
BLUE CROSS NAMPA
ID
01
—
8M879
BLUE CROSS MERIDIAN
ID
01
—
DD7372
RAILROAD MEDICARE
ID
Enumeration date
05/25/2006
Last updated
02/22/2021
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