Individual
MICHAEL SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4815 CLEVELAND BLVD, CALDWELL, ID 83605-6501
(208) 455-3545
(208) 454-9690
Mailing address
5111 N TRAVIS ST APT 221, SHERMAN, TX 75092-4073
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-1447
ID
207Q00000X
Family Medicine Physician
S3590
TX
Other
Enumeration date
04/04/2017
Last updated
02/20/2024
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