MEDICARE: DR. MICHAEL I MUNFORD

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	208600000X	Surgery Physician	4880747-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	870673778MUN	OTHER	UT	EMIA
2	63237	OTHER	UT	PEHP
3	48807471201001	OTHER	UT	BCBS
4	687379	OTHER	UT	DMBA
5	107004053101	OTHER	UT	IHC

General Provider Information

NPI Number	:	1164494076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL I MUNFORD

Provider Business Mailing Address
First Line	:	1251 NORTHFIELD RD
Second Line	:	SUITE 202
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-8622
Country	:	US
Telephone Number	:	435-867-0300
Fax Number	:	435-867-0331

Provider Business Practice Location Address
First Line	:	1251 NORTHFIELD RD
Second Line	:	STE 202
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-8623
Country	:	US
Telephone Number	:	435-867-0300
Fax Number	:	435-867-0331

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	04/11/2017

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Directions to “ DR. MICHAEL I MUNFORD ” Practice Location

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