Provider Demographics
NPI:1629751086
Name:KATHEM, AMEER
Entity Type:Individual
Prefix:
First Name:AMEER
Middle Name:
Last Name:KATHEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S ORCHARD ST STE 99
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1961
Mailing Address - Country:US
Mailing Address - Phone:208-420-6482
Mailing Address - Fax:
Practice Address - Street 1:1111 S ORCHARD ST STE 99
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1961
Practice Address - Country:US
Practice Address - Phone:208-420-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker