Individual
KENNETH VERLAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
510 N 2ND ST STE 102, BOISE, ID 83702-6077
(208) 381-4700
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
M-17493
ID
208800000X
Urology Physician
MD210158
OR
Other
Enumeration date
03/20/2017
Last updated
10/10/2023
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