Healthcare Provider Details

I. General information

NPI: 1174228449
Provider Name (Legal Business Name): MATTHEW AIKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

IV. Provider business mailing address

65 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-3841
  • Fax:
Mailing address:
  • Phone: 801-581-3841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number100470
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number14238961-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: