Organization · NPI-2

Ann Cordum PLLC

Internal Medicine · Boise, ID

NPI number1013383645
StatusActive
Last updated in NPPESAug 18, 2015

Details

NPI
1013383645
Entity type
Organization (NPI-2)
Legal business name
Ann Cordum PLLC
Organization subpart
No
Enumeration date
Aug 18, 2015
Last updated
Aug 18, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal MedicineM-7030IDYes

Practice location

203 W Fort St
Boise, ID 83702-4528

Phone 208-994-8656

Mailing address

203 W Fort St
Boise, ID 83702-4528

Phone 208-994-8656

Authorized official

Ann Alexandra Cordum
Owner
2089948656

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