MR. MICHAEL KENNETH WUCINICH (NPI# 1407223274) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407223274 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL KENNETH WUCINICH |
| Credential | PA-C |
| Practice Address |
775 Pole Line Rd W Ste 302 Twin Falls ID 83301-5823 |
| Mailing Address |
3724 E 3770 N Kimberly ID 83341-5524 |
| Practice Telephone | 2088148725 |
| Mailing Telephone | 2084208188 |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2015-11-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
1274 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
775 POLE LINE RD W STE 302 |
| City | TWIN FALLS |
| State | ID |
| Zip Code | 83301-5823 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043730302 | Lesley D. Goulding | Nurse Practitioner | 775 Pole Line Rd W Ste 302, Twin Falls, ID 83301-5823 | 2017-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023645918 | Matthew Anderson | Pharmacist | Dick's Pharmacy, 526 K Shoup Ave W, Twin Falls, ID 83301 | 2020-03-23 |
| 1780146316 | Frontier Pediatric Partners, Pllc | Pediatrics | 1502 Locust Street N #700, Twin Falls, ID 83301 | 2019-04-02 |
| 1972073377 | Wood River Acupuncture | Acupuncturist | 1625 Addison Ave East, Twin Falls, ID 83301 | 2018-11-28 |
| 1235629874 | Lonnie Paul | Counselor | 1092 Eastland Dr N Ste A, Twin Falls, ID 83301 | 2018-05-17 |
| 1679060966 | Christina Jirapha Thongdee | Social Worker | 625 Poleline Road West, Suite 2a, Twin Falls, ID 83301 | 2018-04-23 |
| 1437658499 | Tyrel Kevin Ward | Chiropractor | 2167 Village Park Ave., Suite 100, Twin Falls, ID 83301 | 2018-02-06 |
| 1851836381 | Tanabell Health Services, Inc | Skilled Nursing Facility | 1134 Cheney Drive West, Twin Falls, ID 83301 | 2016-12-19 |
| 1578005195 | Matthew Carter | Physical Therapist | 1053 Eastland Drive, Twin Falls, ID 83301 | 2016-11-14 |
| 1790227783 | Murvat Usmanova | Nurse Practitioner | 775 Pole Line Road W, Suite 203, Twin Falls, ID 83301 | 2016-11-08 |
| 1265894687 | Shawna Fultz | Social Worker | 1201 Fall Ave East Suite C, Twin Falls, ID 83301 | 2016-03-24 |
| Find all providers in zip 83301 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447652813 | Jessea Camille Whitlow | Physician Assistant | 2392 Addison Ave E, Twin Falls, ID 83301-6745 | 2014-09-17 |
| 1174860878 | Cameron Burgess Freeman | Physician Assistant | 325 Martin Steet, Twin Falls, ID 83301-4536 | 2013-01-15 |
| 1003990573 | David Billings Brown | Physician Assistant | 943 Bitterroot Pl, Twin Falls, ID 83301-4372 | 2006-10-24 |
| 1447217955 | Gail Rae Cook | Physician Assistant | 325 Martin St, Twin Falls, ID 83301-4563 | 2006-04-27 |
| 1902444300 | Jamie Michael Engeldrum | Physician Assistant | 2550 Addison Ave E, Twin Falls, ID 83301-6767 | 2019-12-16 |
| 1023435526 | Psychiatric Services Behavioral Health Clinic, Inc. | Physician Assistant | 493 Eastland Drive, Twin Falls, ID 83301 | 2014-03-21 |
| 1891097234 | Merrick Gordon Reynolds | Physician Assistant | 526 Shoup Ave W, Suite E, Twin Falls, ID 83301-5050 | 2010-11-17 |
| 1376876599 | Jonathan B Pittard | Physician Assistant | 260 Falls Ave Ste C, Twin Falls, ID 83301-3370 | 2009-09-08 |
| 1194909598 | Gladys Marie Rasch | Physician Assistant | 496 Shoup Ave W, Suite #e, Twin Falls, ID 83301-5043 | 2007-12-20 |
| 1831290097 | John Urrutia | Physician Assistant | 176 Falls Avenue, Twin Falls, ID 83301 | 2006-09-26 |
| Find all providers in TWIN FALLS | ||||
| City | TWIN FALLS |
| Zip Code | 83301 |
Please comment or provide details below to improve the information on MR. MICHAEL KENNETH WUCINICH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.