Healthcare Provider Details

I. General information

NPI: 1497753354
Provider Name (Legal Business Name): MICHAEL BRIAN LLOYD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MEDICAL DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

7200 REINDEER DR
SALT LAKE CITY UT
84121-4451
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-7575
  • Fax: 801-285-1704
Mailing address:
  • Phone: 801-733-9594
  • Fax: 801-927-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number341238-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number341238-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: