Provider Demographics
NPI:1003030099
Name:ESTESS, MICHAEL E (M D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:ESTESS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 SHORELINE DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6879
Mailing Address - Country:US
Mailing Address - Phone:208-345-2630
Mailing Address - Fax:208-345-6504
Practice Address - Street 1:1471 SHORELINE DR
Practice Address - Street 2:SUITE 119
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6879
Practice Address - Country:US
Practice Address - Phone:208-345-2630
Practice Address - Fax:208-345-6504
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-31732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010003612OtherBLUE SHIELD
IDDG399OtherBLUE CROSS
1109212Medicare ID - Type Unspecified
IDC36812Medicare UPIN