Organization
KORMYLO ORTHOPEDIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARKUS A KORMYLO C.P.O. (PRESIDENT - OWNER)
(208) 377-4024
Entity
Organization
Contact information
Practice address
175 N BENJAMIN LN, BOISE, ID 83704-8328
(208) 377-4024
(208) 375-8522
Mailing address
175 N BENJAMIN LN, BOISE, ID 83704-8328
(208) 377-4024
(208) 375-8522
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8069839
—
ID
Enumeration date
07/31/2006
Last updated
03/16/2010
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