Individual
MICHAEL A ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1000 POCATELLO CREEK RD STE E10, POCATELLO, ID 83201-2953
(208) 648-4789
(208) 648-4790
Mailing address
1000 POCATELLO CREEK RD STE E10, POCATELLO, ID 83201-2953
(208) 648-4789
(208) 648-4790
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-1136
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124406816
—
ID
Enumeration date
05/11/2015
Last updated
08/19/2025
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