Provider Demographics
NPI:1053675629
Name:KOOTENAI KIDS PEDIATRICS PLLC
Entity Type:Organization
Organization Name:KOOTENAI KIDS PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:AKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-773-5437
Mailing Address - Street 1:761 N THORNTON ST
Mailing Address - Street 2:STE A
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6105
Mailing Address - Country:US
Mailing Address - Phone:208-773-5437
Mailing Address - Fax:
Practice Address - Street 1:761 N THORNTON ST
Practice Address - Street 2:STE A
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6105
Practice Address - Country:US
Practice Address - Phone:208-773-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty