Healthcare Provider Details

I. General information

NPI: 1760550628
Provider Name (Legal Business Name): MICHELLE G HOFMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE G ELBOGEN

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

295 CHIPETA WAY UOFU SOM-DEPT OF PEDIATRICS
SALT LAKE CITY UT
84108-1220
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-3645
  • Fax: 801-662-3664
Mailing address:
  • Phone: 801-587-7400
  • Fax: 801-587-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number282612-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number282612-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierD5781
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 2
Identifier0142259
Identifier TypeMEDICAID
Identifier StateMT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: