| Idaho Center For Regenerative Medicine | |
|
868 E Riverside Dr Suite 170 Eagle ID 83616-5412 | |
| (208) 995-2802 | |
| (208) 995-2804 |
| Full Name | Idaho Center For Regenerative Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 868 E Riverside Dr, Eagle, Idaho |
| Authorized Official Name and Position | Robert J Haake (PHYSICIAN) |
| Authorized Official Contact | 2089952802 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Center For Regenerative Medicine 868 E Riverside Dr Suite 170 Eagle ID 83616-5412 Ph: (208) 995-2802 | Idaho Center For Regenerative Medicine 868 E Riverside Dr Suite 170 Eagle ID 83616-5412 Ph: (208) 995-2802 |
| NPI Number | 1407273147 |
|---|---|
| Provider Enumeration Date | 03/19/2014 |
| Last Update Date | 03/17/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407273147 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 207R00000X (Idaho) | Primary |
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