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NPI Code Detail

MEDICARE: MICHAEL K VISICK MD

MEDICARE: MICHAEL K VISICK MD
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
1208000000XPediatrics Physician4739087-1205UT

General Provider Information

NPI Number : 1225048648
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL K VISICK MD
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SLC
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 435-716-1940
Fax Number :
Provider Business Practice Location Address
First Line : 506 LAKE ST
Second Line :
City : KENAI
State : AK
Zip : 99611-6937
Country : US
Telephone Number : 907-714-4111
Fax Number : 844-412-3952
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 12/13/2023

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