Healthcare Provider Details

I. General information

NPI: 1295439636
Provider Name (Legal Business Name): MICHAEL AMEDEO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 S COTTONWOOD ST STE 303
MURRAY UT
84107-6768
US

IV. Provider business mailing address

10789 OHIO AVE APT 4
LOS ANGELES CA
90024-5054
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3747
  • Fax:
Mailing address:
  • Phone: 301-514-8024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: