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General NPI Number Information
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NPI Number | 1073616082
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Entity Type | Individual
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Provider Name | MICHAEL C MEYTHALER MD
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2003 LINCOLN WAY
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City | CAEUR D'ALEN
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State | ID
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Zip | 83814
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Country | US
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Telephone | 208-666-2000
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Fax | 208-666-3963
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Provider Business Mailing Address
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Address Line | 2003 LINCOLN WAY
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City | CAEUR D'ALEN
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State | ID
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Zip | 83814
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Country | US
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Telephone | 208-666-2000
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Fax | 208-666-3963
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | TL3767
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License Number State | ID
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