Provider Demographics
NPI:1851646731
Name:PAUL, KRISTIN MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:PAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2390
Practice Address - Street 1:1551 E MULLAN AVE BLDG A
Practice Address - Street 2:STE 200B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9005
Practice Address - Country:US
Practice Address - Phone:208-262-2213
Practice Address - Fax:208-262-2214
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-14169207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1851646731Medicaid