Individual
MARK MICHAUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1907 S BROADWAY AVE STE 101, BOISE, ID 83706-4201
(208) 345-1222
(208) 345-1261
Mailing address
1907 S BROADWAY AVE STE 101, BOISE, ID 83706-4201
(208) 345-1222
(208) 345-1261
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M8634
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806407800
—
ID
Enumeration date
06/02/2006
Last updated
02/10/2010
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