Individual
MICHAEL ALLAN HALLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5015
(208) 381-1873
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5015
(208) 381-1873
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
ID
Other
Enumeration date
05/17/2016
Last updated
03/17/2018
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