Idaho Center for Regenerative Medicine

NPI #1407273147 in Eagle, Idaho

Provider Information

NPI Number: 1407273147
Entity Type: Organization
Organization Name: Idaho Center for Regenerative Medicine
Primary Specialty: Internal Medicine
Enumeration Date: Mar 19, 2014
Last Updated: Mar 17, 2016

Practice Location

Address: 868 E RIVERSIDE DR
Address 2: SUITE 170
City: Eagle
State: Idaho
ZIP Code: 83616-5412
Phone: (208) 995-2802

Authorized Official

Name: DR. ROBERT J HAAKE, D.O.
Title: PHYSICIAN
Phone: (208) 995-2802

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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