Healthcare Provider Details

I. General information

NPI: 1538254453
Provider Name (Legal Business Name): STEVEN B. KURTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 POLE LINE RD W STE 301
TWIN FALLS ID
83301-5823
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-8700
  • Fax:
Mailing address:
  • Phone: 208-381-8748
  • Fax: 702-385-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number7771
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: