Provider Demographics
NPI:1548452683
Name:KASHIRNY, SERGEI V (MD)
Entity type:Individual
Prefix:
First Name:SERGEI
Middle Name:V
Last Name:KASHIRNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SERHIY
Other - Middle Name:
Other - Last Name:KASHYRNYY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:125 E IDAHO ST STE 300
Mailing Address - Street 2:NEUROLOGY
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6256
Mailing Address - Country:US
Mailing Address - Phone:208-381-7335
Mailing Address - Fax:
Practice Address - Street 1:125 E IDAHO ST STE 300
Practice Address - Street 2:NEUROLOGY
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6256
Practice Address - Country:US
Practice Address - Phone:208-381-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-115402084N0400X
MTMED-PHYS-LIC-257982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20001226Medicare PIN
LA1005959Medicaid