Healthcare Provider Details

I. General information

NPI: 1982779815
Provider Name (Legal Business Name): MICHAEL D LAHEY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E RIVERSIDE DRIVE SUITE 234
EAGLE ID
83616
US

IV. Provider business mailing address

323 E RIVERSIDE DRIVE SUITE 234
EAGLE ID
83616
US

V. Phone/Fax

Practice location:
  • Phone: 208-938-4080
  • Fax: 208-938-8922
Mailing address:
  • Phone: 208-938-4080
  • Fax: 208-938-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM5743
License Number StateID

VIII. Authorized Official

Name: DR. MICHAEL DUANE LAHEY
Title or Position: M.D.
Credential: M.D.
Phone: 208-938-4080