Anderson, Michael A

Anderson, Michael A is an individual health care provider with primary practice located at 1000 Pocatello Creek Rd Ste E10 , Pocatello ID 83201-2953. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Anderson, Michael A can be contacted via phone (208) 648-4789.

Contact Information

Primary practice address
1000 Pocatello Creek Rd Ste E10 Pocatello ID 83201-2953
Phone: (208) 648-4789
Fax: (208) 648-4790
Website:
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Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X Michigan
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X O-1136 Idaho

Profile Details

NPI number 1124406186
LBN Legal business name Anderson, Michael A
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2015
Last updated Jun 17th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124406186 NPPES
Idaho MEDICAID 1124406816

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