Provider Demographics
NPI:1225904683
Name:HATFIELD, MIKAEL DAVID (CPRC)
Entity type:Individual
Prefix:
First Name:MIKAEL
Middle Name:DAVID
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:CPRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 N SCHREIBER WAY STE B
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8395
Mailing Address - Country:US
Mailing Address - Phone:208-261-9948
Mailing Address - Fax:
Practice Address - Street 1:3918 N SCHREIBER WAY STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8395
Practice Address - Country:US
Practice Address - Phone:208-261-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID13066175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist