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General NPI Number Information
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NPI Number | 1598778136
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Entity Type | Individual
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Provider Name | KENNETH JOHN GRAMYK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 6051 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-8969
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Country | US
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Telephone | 208-302-5150
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Fax | 208-302-5155
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Provider Business Mailing Address
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Address Line | PO BOX 190930
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City | BOISE
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State | ID
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Zip | 83719-0930
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Country | US
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Telephone | 83-675-1702
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Fax | 208-367-5180
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M6718
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License Number State | ID
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