Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Idaho Center for Regenerative Medicine

Organization Internal Medicine Physician · NPI 1407273147

Idaho Center for Regenerative Medicine is an Internal Medicine Physician in Eagle, Idaho. Licensed in Idaho. Registered with an NPI since 2014.

Licensed in
ID
In the registry since
2014

Practice location Address checks out

868 E Riverside Dr Ste 170
Eagle, ID 83616-5412
Phone: (208) 995-2802
Fax: (208) 995-2804
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 207R00000X (ID)

Record details

NPI number1407273147
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Haake — Physician · (208) 995-2802
NPI enumeratedMarch 19, 2014
Last updated in NPPESMarch 17, 2016
Mailing address868 E Riverside Dr, Suite 170, Eagle, ID 83616-5412

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