Kieckbusch, Mark E
Kieckbusch, Mark E is an individual health care provider with primary practice located at 190 E Bannock St , Boise ID 83712-6241. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, Allopathic & Osteopathic Physicians / Hematology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is his primary health care specialty. Kieckbusch, Mark E can be contacted via phone (208) 381-2367.Contact Information
Primary practice address
190 E Bannock St
Boise ID 83712-6241
Phone: (208) 381-2367
Fax: (208) 381-4762
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | M6070 | Idaho |
| Allopathic & Osteopathic Physicians / Hematology | 207ZH0000X | M6070 | Idaho |
Profile Details
| NPI number | 1215981410 |
|---|---|
| LBN Legal business name | Kieckbusch, Mark E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 20th, 2006 |
| Last updated | Dec 11th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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