Individual
RONALD F MICIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5810
(208) 814-4100
(208) 814-4908
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
M4130
ID
208M00000X
Hospitalist Physician
Primary
M4130
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002543700
—
ID
01
—
P00029390
RR MEDICARE
ID
Enumeration date
06/08/2006
Last updated
05/03/2019
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