Kyle Phillip Dietrich, PA STUDENT is a
Student In An Organized Health Care Education/training Program based in Pocatello, Idaho. Kyle Phillip Dietrich is licensed to practice in * (Not Available) (license number ) and his current practice location is
921 S 8th Ave Stop 8253, Pocatello, Idaho. He can be reached at his office (for appointments etc.) via phone at
(208) 282-4726.
NPI number for Kyle Phillip Dietrich is 1932661352 and his current mailing address is 921 S 8th Ave Stop 8253, Pocatello, Idaho. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1932661352.
Healthcare Provider's Profile
| Full Name | Kyle Phillip Dietrich |
|---|
| Gender | Male |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 921 S 8th Ave Stop 8253, Pocatello, Idaho |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1932661352
- Provider Enumeration Date: 04/03/2019
- Last Update Date: 05/05/2024
Medical Identifiers
Medical identifiers for Kyle Phillip Dietrich such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1932661352 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225700000X | Massage Therapist | LMT-LMT-LIC-15881 (Montana) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kyle Phillip Dietrich is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kyle Phillip Dietrich, PA STUDENT
921 S 8th Ave Stop 8253,
Pocatello, ID 83209-0002
Ph: (208) 282-4726 | Kyle Phillip Dietrich, PA STUDENT
921 S 8th Ave Stop 8253,
Pocatello, ID 83209-0002
Ph: (208) 282-4726 |
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