MEDICARE: KATIE VANCLEAVE DO

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	207V00000X	Obstetrics & Gynecology Physician	O-1803	ID

General Provider Information

NPI Number	:	1821551359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE VANCLEAVE DO

Provider Business Mailing Address
First Line	:	2003 KOOTENAI HEALTH WAY
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83814-6051
Country	:	US
Telephone Number	:	208-625-4970
Fax Number	:	208-625-4991

Provider Business Practice Location Address
First Line	:	566 W PRAIRIE AVE
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-7766
Country	:	US
Telephone Number	:	208-625-4970
Fax Number	:	208-625-4991

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

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	12/18/2025

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Directions to “ KATIE VANCLEAVE DO” Practice Location

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