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General NPI Number Information
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NPI Number | 1881611424
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Entity Type | Individual
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Provider Name | CHARLES MICHAEL RASMUSSEN MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD STE 2205
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City | MERIDIAN
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State | ID
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Zip | 83642-6308
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Country | US
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Telephone | 208-884-0036
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Fax | 208-884-3805
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Provider Business Mailing Address
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Address Line | 1070 N CURTIS RD STE 125
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City | BOISE
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State | ID
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Zip | 83706-1238
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Country | US
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Telephone | 208-377-1415
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Fax | 208-375-3451
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | M6484
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License Number State | ID
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