Healthcare Provider Details

I. General information

NPI: 1003306754
Provider Name (Legal Business Name): MICHEAL GEORGE ADONDAKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N CURTIS RD
BOISE ID
83706-1309
US

IV. Provider business mailing address

877 W MAIN ST STE 603
BOISE ID
83702-6070
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-2121
  • Fax: 706-596-6720
Mailing address:
  • Phone: 208-954-8070
  • Fax: 208-954-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number69822
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD216181
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM-17306
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: