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NPI Code Detail

MEDICARE: DR. JOHN KODATT MD

MEDICARE: DR. JOHN KODATT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianR6281KY
2207Q00000XFamily Medicine Physician2171959ID
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1083354039
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN KODATT MD
Provider Business Mailing Address
First Line : PO BOX 190930
Second Line :
City : BOISE
State : ID
Zip : 83719-0930
Country : US
Telephone Number : 208-302-9342
Fax Number :
Provider Business Practice Location Address
First Line : 1510 12TH AVE RD STE 200
Second Line :
City : NAMPA
State : ID
Zip : 83686-6946
Country : US
Telephone Number : 208-302-6800
Fax Number : 208-302-6855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2022
Last Update Date : 09/18/2025

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