Individual
DR. MICHAEL D SEVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 S EAGLE RD, SUITE 1222, MERIDIAN, ID 83642-6351
(208) 947-2266
(208) 947-2267
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
M8793
ID
208VP0000X
Pain Medicine Physician
Primary
M8793
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806625400
—
ID
01
—
P00036983
RAILROAD MEDICARE
ID
Enumeration date
11/02/2005
Last updated
01/18/2024
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