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General NPI Number Information
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NPI Number | 1326412644
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Entity Type | Organization
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Legal Business Name | KENNETH E KRELL MD PA
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Dates
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Enumeration Date | 11/24/2015
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 3100 CHANNING WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7533
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Country | US
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Telephone | 208-227-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 7711 S 1ST E
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7731
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KENNETH KRELL
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Credential | MD
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Telephone | 208-313-5755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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