Healthcare Provider Details

I. General information

NPI: 1063648541
Provider Name (Legal Business Name): MICHAEL JAMES GROVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W 465 N STE 604
PROVIDENCE UT
84332-8006
US

IV. Provider business mailing address

560 W 465 N STE 604
PROVIDENCE UT
84332-8006
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-1600
  • Fax: 435-753-9521
Mailing address:
  • Phone: 435-753-1600
  • Fax: 435-753-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number274555
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD451410
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberND451410
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: