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General NPI Number Information
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NPI Number | 1437194552
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Entity Type | Individual
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Provider Name | MARY O'KIEF DITTRICH MD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3525 E LOUISE DR STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-6302
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Country | US
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Telephone | 208-846-8335
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 HOLDEN LN
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City | BOISE
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State | ID
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Zip | 83706-5060
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | M7706
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License Number State | ID
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