Provider Demographics
NPI:1598843039
Name:CSANKY, JUDITH ERIKA (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ERIKA
Last Name:CSANKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISZTIAN
Other - Middle Name:JUDITH
Other - Last Name:ERIKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2156 EAGLECREST DR
Mailing Address - Street 2:
Mailing Address - City:FILER
Mailing Address - State:ID
Mailing Address - Zip Code:83328-5068
Mailing Address - Country:US
Mailing Address - Phone:503-505-3628
Mailing Address - Fax:
Practice Address - Street 1:1411 FALLS AVE E STE 1151
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3455
Practice Address - Country:US
Practice Address - Phone:208-933-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26092207RG0100X
IDM11559207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287276Medicaid
ID1598843039Medicaid
OR287276Medicaid
ID1598843039Medicaid
ID20000213Medicare PIN