Healthcare Provider Details

I. General information

NPI: 1245222819
Provider Name (Legal Business Name): MICHAEL T. SWINYARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 W SOUTH JORDAN PKWY STE 103
SOUTH JORDAN UT
84095-4712
US

IV. Provider business mailing address

1258 W S JORDAN PKWY STE 103
SOUTH JORDAN UT
84095-4712
US

V. Phone/Fax

Practice location:
  • Phone: 801-838-9090
  • Fax: 801-838-9092
Mailing address:
  • Phone: 801-838-9090
  • Fax: 801-838-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number292580-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: