Provider Demographics
NPI:1447253232
Name:KRAFFT, KEVIN R (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:KRAFFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1000 N CURTIS RD
Mailing Address - Street 2:STE 202
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1346
Mailing Address - Country:US
Mailing Address - Phone:208-377-3435
Mailing Address - Fax:208-377-3147
Practice Address - Street 1:1000 N CURTIS RD
Practice Address - Street 2:STE 202
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1346
Practice Address - Country:US
Practice Address - Phone:208-377-3435
Practice Address - Fax:208-377-3147
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM7222225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804140000Medicaid
ID1137019Medicare ID - Type Unspecified
ID804140000Medicaid