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Organization

MICHAEL E. ESTESS, M. D. CHARTERED

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MICHAEL E. ESTESS M. D. (PRESIDENT)
(208) 345-2630
Entity
Organization

Contact information

Practice address
1471 SHORELINE DR, SUITE 119, BOISE, ID 83702-6879
(208) 345-2630
(208) 345-6504
Mailing address
1471 SHORELINE DR, SUITE 119, BOISE, ID 83702-6879
(208) 345-2630
(208) 345-6504

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
M-3173
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010003612
BLUE SHIELD
ID
01
DG399
BLUE CROSS
ID
Enumeration date
04/12/2007
Last updated
08/22/2020
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