# IDAHO OCCUPATIONAL MEDICINE GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Coeur d Alene Spine and Sport
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366908949
- **Authorized official:** DR. MICHAEL ALAN LUDWIG MD (OWNER)
- **Authorized official phone:** (208) 765-0156

## Contact information

- **Practice address:** 1839 N GOVERNMENT WAY, COEUR D ALENE, ID 83814-3454
- **Practice address phone:** (208) 765-0156
- **Practice address fax:** (208) 292-3177
- **Mailing address:** 1839 N GOVERNMENT WAY, COEUR D ALENE, ID 83814-3454
- **Mailing address phone:** (208) 765-0156
- **Mailing address fax:** (208) 292-3177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/19/2019
- **Last updated:** 08/25/2021