Provider Demographics
NPI:1144255639
Name:STRAIT, KEVIN BURTON (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BURTON
Last Name:STRAIT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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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:208-262-7461
Practice Address - Street 1:1551 E MULLAN AVE STE 200C
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9005
Practice Address - Country:US
Practice Address - Phone:208-618-2570
Practice Address - Fax:208-618-8779
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDO-0423207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09817Medicare UPIN