Graham, Michael Clyde

Graham, Michael Clyde is an individual health care provider with primary practice located at 225 6Th St , Potlatch ID 83855-5002. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Graham, Michael Clyde can be contacted via phone (208) 883-2220.

Contact Information

Primary practice address
225 6Th St Potlatch ID 83855-5002
Phone: (208) 883-2220
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA594 Idaho

Profile Details

NPI number 1205901477
LBN Legal business name Graham, Michael Clyde
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 22nd, 2006
Last updated Jun 20th, 2012 - about 13 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 1205901477 NPPES
Idaho MEDICAID 807364300

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