MEDICARE: MICHAEL ANDERSON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	10117275-1206	UT

General Provider Information

NPI Number	:	1023569241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANDERSON PA

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:	ATTN: CREDENTIALING
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-357-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 N 500 W STE 101
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3305
Country	:	US
Telephone Number	:	801-373-4366
Fax Number	:	801-418-0941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	04/07/2026

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Directions to “ MICHAEL ANDERSON PA” Practice Location

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