Individual
SHEEV INDRAVADAN DATTANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1072 N LIBERTY STREET, STE 201, BOISE, ID 83704
(208) 302-2400
(208) 302-2455
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 302-2400
(208) 302-2455
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
ME133177
FL
208C00000X
Colon & Rectal Surgery Physician
Primary
M-13990
ID
Other
Enumeration date
07/05/2017
Last updated
07/19/2018
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