Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KENNETH TODD BLACKNER, M.D.
Active Sole ProprietorKENNETH TODD BLACKNER, M.D. is a General Practice healthcare provider located in SHELLEY, Idaho. NPI 1043339641 is currently active in the NPPES registry. Verify at CMS.
General Practice · SHELLEY, ID
Registration Details
- NPI Number
- 1043339641
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Mar 28, 2007 (19.35676951314 yrs)
- Last Updated
- Feb 3, 2016
- Licenses
-
0101240258 (VA)M-11785 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
275 W LOCUST STSHELLEY, ID, 832741230Browse ID providers · Browse ZIP 83274
- Phone
- 2083573960
- Primary Specialty
-
General Practice
208D00000X
- Additional Specialty
- General Practice
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.