Healthcare Provider Details

I. General information

NPI: 1275787996
Provider Name (Legal Business Name): MICHAEL BRENT MADSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 11/09/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 W 2200 S SUITE 200
SALT LAKE CITY UT
84119-1485
US

IV. Provider business mailing address

1405 WEST 2200 SOUTSH
SALT LAKE CITY UT
84119
US

V. Phone/Fax

Practice location:
  • Phone: 801-973-0900
  • Fax:
Mailing address:
  • Phone: 801-973-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number159391-1265,8905
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number159391-1205, 8905
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: