Provider Demographics
NPI:1427619998
Name:FREY, MICHAELA (MD)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:FREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2307 W COMPASS DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2307 W COMPASS DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0318
Practice Address - Country:US
Practice Address - Phone:541-633-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMRM-2024207Q00000X
390200000X
WI83668-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program