Healthcare Provider Details

I. General information

NPI: 1164429643
Provider Name (Legal Business Name): MICHAEL A PATMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W PRAIRIE AVE
COEUR D ALENE ID
83815-8780
US

IV. Provider business mailing address

2039 N WOLFE PENN ST
LIBERTY LAKE WA
99019-5109
US

V. Phone/Fax

Practice location:
  • Phone: 208-209-0288
  • Fax:
Mailing address:
  • Phone: 208-871-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM-10058
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: