MEDICARE: KATHERINE N DORSETT M.D.

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
1	2084N0400X	Neurology Physician	8071382	ID
2	2084N0400X	Neurology Physician	4351047918	MI

General Provider Information

NPI Number	:	1093393639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE N DORSETT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4168
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83205-4168
Country	:	US
Telephone Number	:	208-239-1035
Fax Number	:	208-239-3626

Provider Business Practice Location Address
First Line	:	777 HOSPITAL WAY
Second Line	:	SUITE G-15
City	:	POCATELLO
State	:	ID
Zip	:	83201-5175
Country	:	US
Telephone Number	:	208-239-2722
Fax Number	:	208-239-3759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	03/11/2026

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