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NPI Code Detail

MEDICARE: DR. VIVEK KANTAYYA MD

MEDICARE: DR. VIVEK KANTAYYA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036081072IL
2207Q00000XFamily Medicine PhysicianM-12703ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437132479
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VIVEK KANTAYYA MD
Provider Business Mailing Address
First Line : 3063 S OLD HICKORY ST
Second Line :
City : BOISE
State : ID
Zip : 83716-5812
Country : US
Telephone Number : 815-871-3628
Fax Number :
Provider Business Practice Location Address
First Line : 300 S 23RD ST
Second Line :
City : BOISE
State : ID
Zip : 83702-9100
Country : US
Telephone Number : 208-344-3512
Fax Number : 208-344-4898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 06/09/2015

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Directions to “ DR. VIVEK KANTAYYA MD” Practice Location

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