Provider Demographics
NPI:1558585455
Name:MICHAEL E. ESTESS, M. D. CHARTERED
Entity type:Organization
Organization Name:MICHAEL E. ESTESS, M. D. CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESTESS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:208-345-2630
Mailing Address - Street 1:1471 SHORELINE DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6879
Mailing Address - Country:US
Mailing Address - Phone:208-345-2630
Mailing Address - Fax:208-345-6504
Practice Address - Street 1:1471 SHORELINE DR
Practice Address - Street 2:SUITE 119
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6879
Practice Address - Country:US
Practice Address - Phone:208-345-2630
Practice Address - Fax:208-345-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-3173305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010003612OtherBLUE SHIELD
IDDG399OtherBLUE CROSS
IDDG399OtherBLUE CROSS
ID000010003612OtherBLUE SHIELD
IDDG399OtherBLUE CROSS