Individual
DR. MICHAEL PESTOTNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 WEST FORT ST, #111R, BOISE, ID 83702
(208) 422-1314
Mailing address
500 WEST FORT ST, #111R, BOISE, ID 83702
(208) 422-1314
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11029172-1205
UT
Other
Enumeration date
04/05/2016
Last updated
11/11/2021
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