Individual
STEPHEN A WASILEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
191 5TH STREET WEST, KETCHUM, ID 83340
(208) 726-5207
(208) 726-8948
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M5774
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002717800
—
ID
01
—
P01032143
MCRR
ID
Enumeration date
06/09/2006
Last updated
09/06/2012
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