Provider Demographics
NPI:1407629876
Name:THATCHER, MICAH
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:THATCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N 3000 E
Mailing Address - Street 2:
Mailing Address - City:SUGAR CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83448-1220
Mailing Address - Country:US
Mailing Address - Phone:208-351-6081
Mailing Address - Fax:
Practice Address - Street 1:2 N 3000 E
Practice Address - Street 2:
Practice Address - City:SUGAR CITY
Practice Address - State:ID
Practice Address - Zip Code:83448-1220
Practice Address - Country:US
Practice Address - Phone:208-351-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program