Healthcare Provider Details

I. General information

NPI: 1801945308
Provider Name (Legal Business Name): ORIE E KALTENBAUGH, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 SAINT JOHNS WAY
LEWISTON ID
83501-2435
US

IV. Provider business mailing address

307 SAINT JOHNS WAY
LEWISTON ID
83501-2435
US

V. Phone/Fax

Practice location:
  • Phone: 208-746-5132
  • Fax: 208-746-0087
Mailing address:
  • Phone: 208-746-5132
  • Fax: 208-746-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM3226
License Number StateID

VIII. Authorized Official

Name: ORIE E KALTENBAUGH
Title or Position: OWNER
Credential: M.D.
Phone: 208-746-5132