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General NPI Number Information
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NPI Number | 1982779815
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Entity Type | Organization
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Legal Business Name | MICHAEL D LAHEY MD LLC
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 323 E RIVERSIDE DRIVE SUITE 234
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City | EAGLE
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State | ID
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Zip | 83616
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Country | US
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Telephone | 208-938-4080
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Fax | 208-938-8922
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Provider Business Mailing Address
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Address Line | 323 E RIVERSIDE DRIVE SUITE 234
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City | EAGLE
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State | ID
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Zip | 83616
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Country | US
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Telephone | 208-938-4080
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Fax | 208-938-8922
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Authorized Official
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Title or Position | M.D.
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Name | DR. MICHAEL DUANE LAHEY
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Credential | M.D.
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Telephone | 208-938-4080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M5743
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License Number State | ID
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