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General NPI Number Information
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NPI Number | 1366908949
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Entity Type | Organization
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Legal Business Name | IDAHO OCCUPATIONAL MEDICINE GROUP
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 1839 N GOVERNMENT WAY
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3454
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Country | US
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Telephone | 208-765-0156
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Fax | 208-292-3177
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Provider Business Mailing Address
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Address Line | 1839 N GOVERNMENT WAY
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3454
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Country | US
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Telephone | 208-765-0156
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Fax | 208-292-3177
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL ALAN LUDWIG
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Credential | MD
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Telephone | 208-765-0156
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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 |
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License Number State |
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