Provider Demographics
NPI:1265486625
Name:BATHINA, MURALI N (MD)
Entity Type:Individual
Prefix:
First Name:MURALI
Middle Name:N
Last Name:BATHINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-322-1680
Mailing Address - Fax:208-322-1695
Practice Address - Street 1:315 E ELM STREET
Practice Address - Street 2:STE 350
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605
Practice Address - Country:US
Practice Address - Phone:208-454-6363
Practice Address - Fax:208-454-3512
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM6347207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease