Provider Demographics
NPI:1407800865
Name:DEUTSCH, KIRSTEN M (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:M
Last Name:DEUTSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:M
Other - Last Name:MAAKESTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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:208-381-2222
Mailing Address - Fax:
Practice Address - Street 1:3301 N SAWGRASS WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4493
Practice Address - Country:US
Practice Address - Phone:208-375-0862
Practice Address - Fax:208-375-2658
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000172092207Q00000X
MN50492207Q00000X
IDM11773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO80164827OtherRR MEDICARE
MO205171101Medicaid
MO80164827OtherRR MEDICARE
H28861Medicare UPIN
MN080017220Medicare PIN