Healthcare Provider Details

I. General information

NPI: 1346935061
Provider Name (Legal Business Name): MATTHEW THOMAS USEVITCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 N 300 W
PROVO UT
84604-6124
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-1200
  • Fax: 801-357-1239
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14269622-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: