Healthcare Provider Details

I. General information

NPI: 1609445808
Provider Name (Legal Business Name): MICHAEL FELLEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WIND RIVER DR
LAYTON UT
84040-7461
US

IV. Provider business mailing address

75 WIND RIVER DR
LAYTON UT
84040-7461
US

V. Phone/Fax

Practice location:
  • Phone: 385-427-2131
  • Fax:
Mailing address:
  • Phone: 385-427-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number14252237-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: