Organization
KENNETH M LITTLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH M LITTLE MD (OWNER)
(208) 367-3500
Entity
Organization
Contact information
Practice address
6140 W CURTISIAN AVE, SUITE 400, BOISE, ID 83704-8880
(208) 367-3500
(208) 367-2968
Mailing address
6140 W CURTISIAN AVE, SUITE 400, BOISE, ID 83704-8880
(208) 367-3500
(208) 367-2968
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
M8861
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152027
REGENCE BLUE SHIELD
—
01
—
8L972
BLUE CROSS OF IDAHO
—
Enumeration date
07/11/2008
Last updated
07/01/2011
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