NPIMap

Individual provider Active NPI

Kenneth John Wakefield, M.D.

  • Allergy Physician
  • Coeur D Alene, ID
National Provider Identifier
1306832688
Registry record updated Feb 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
M-9596 Issued in ID
Practice address
3731 N Ramsey Rd
Suite 150
Coeur D Alene, ID 83815-9000
Phone
(208) 665-1552
Fax
(208) 665-1558
NPI assigned
Sep 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X M-9596 ID Primary

Addresses

Primary practice location

3731 N Ramsey Rd
Suite 150
Coeur D Alene, ID 83815-9000

Mailing address

4304 N 16TH St
Coeur D Alene, ID 83815-9414
Phone (208) 664-3576

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-9596IDMDAllergy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC Past Accepting new patients
Asthma & Allergy of Idaho PastSince Apr 1, 2009 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202860800000",
    "number": "1306832688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4304 N 16TH ST",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838159414",
            "telephone_number": "208-664-3576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3731 N RAMSEY RD",
            "address_2": "SUITE 150",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838159000",
            "telephone_number": "208-665-1552",
            "fax_number": "208-665-1558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKEFIELD",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2008-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "ID",
            "license": "M-9596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.