Individual
DR. MICHAEL J CITRONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2094
(208) 381-1791
Mailing address
PO BOX 1108, CORVALLIS, OR 97339-1108
(208) 381-2094
(208) 381-1791
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
10021
ND
2085R0202X
Diagnostic Radiology Physician
Primary
M9416
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13523
—
ND
01
—
25863
BCBS
ND
05
—
807613900
—
ID
Enumeration date
08/08/2006
Last updated
01/10/2018
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