Provider Demographics
NPI:1154343309
Name:HAJJAR, MICHAEL V (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:HAJJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6140 W CURTISIAN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8907
Mailing Address - Country:US
Mailing Address - Phone:208-327-5600
Mailing Address - Fax:208-327-5602
Practice Address - Street 1:6140 W CURTISIAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8907
Practice Address - Country:US
Practice Address - Phone:208-327-5600
Practice Address - Fax:208-327-5602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM8870207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID100000759058OtherREGENCE BLUESHIELD OF IDAHO
202654900OtherUS OWPC
OR227537OtherOMAP
ID1154343309Medicaid
IDB5707OtherBLUE CROSS OF IDAHO
IDB5707OtherBLUE CROSS OF IDAHO
202654900OtherUS OWPC
179481OtherWASHINGTON DEPT OF LABOR
IDP00152856Medicare PIN
ID1105263Medicare PIN
202654900OtherUS OWPC