Healthcare Provider Details

I. General information

NPI: 1649859257
Provider Name (Legal Business Name): MICHAEL S. CHAMBERLAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD STE 2815
OGDEN UT
84403-3326
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-7880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number12994411-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: