Provider Demographics
NPI:1629111497
Name:JAMES, MICHAEL K (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:JAMES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 S HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7981
Mailing Address - Country:US
Mailing Address - Phone:208-528-6225
Mailing Address - Fax:208-528-8022
Practice Address - Street 1:3345 S HOLMES AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7981
Practice Address - Country:US
Practice Address - Phone:208-528-6225
Practice Address - Fax:208-528-8022
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP140-7213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629111497OtherNPI
IDP140-7OtherBLUE CROSS
ID001310400Medicaid
ID000010015609OtherBLUE SHIELD
ID5356980001Medicare NSC
1350728Medicare PIN
1629111497OtherNPI