MEDICARE: DR. KENNETH E KRELL 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	M4522	ID
2	207R00000X	Internal Medicine Physician	M4522	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518016062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH E KRELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 742337
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2860 CHANNING WAY STE 221
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7541
Country	:	US
Telephone Number	:	208-535-4000
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2022

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