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NPI Code Detail

MEDICARE: KELLY MCGRATH MD

MEDICARE:   KELLY  MCGRATH  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 PhysicianM6320ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2F25998OTHERIDUPIN #

General Provider Information

NPI Number : 1609871060
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MCGRATH MD
Provider Business Mailing Address
First Line : 2003 KOOTENAI HEALTH WAY
Second Line :
City : COEUR D ALENE
State : ID
Zip : 83814-6051
Country : US
Telephone Number : 208-476-5777
Fax Number : 208-476-5385
Provider Business Practice Location Address
First Line : 301 CEDAR ST
Second Line :
City : OROFINO
State : ID
Zip : 83544-9029
Country : US
Telephone Number : 208-476-4555
Fax Number : 208-476-5385
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 08/06/2021

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Directions to “ KELLY MCGRATH MD” Practice Location

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