Healthcare Provider Details

I. General information

NPI: 1629707740
Provider Name (Legal Business Name): CARDIAC AND ARRHYTHMIA CENTER OF IDAHO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 E. ST LUKE'S ST SUITE 100
MERIDIAN ID
83642-6245
US

IV. Provider business mailing address

PO BOX 45308
BOISE ID
83711-5308
US

V. Phone/Fax

Practice location:
  • Phone: 208-579-6300
  • Fax: 208-595-9005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KARL UNDESSER
Title or Position: OWNER
Credential: MD
Phone: 208-447-6741