Healthcare Provider Details

I. General information

NPI: 1598792863
Provider Name (Legal Business Name): BILL THOMAS LAITINEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILLIAM T LAITINEN MD

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S PARADISE AVE
MIDDLETON ID
83644-5809
US

IV. Provider business mailing address

PO BOX 9
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-585-0048
  • Fax: 208-466-5359
Mailing address:
  • Phone: 208-466-7869
  • Fax: 208-466-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM9495
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: