MEDICARE: DR. MICHAEL D SEVERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	M8793	ID
2	208VP0000X	Pain Medicine Physician	M8793	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00036983	OTHER	ID	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205827904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL D SEVERSON MD

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S EAGLE RD
Second Line	:	SUITE 1222
City	:	MERIDIAN
State	:	ID
Zip	:	83642-6351
Country	:	US
Telephone Number	:	208-947-2266
Fax Number	:	208-947-2267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	01/18/2024

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Directions to “ DR. MICHAEL D SEVERSON MD” Practice Location

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