Healthcare Provider Details

I. General information

NPI: 1306936901
Provider Name (Legal Business Name): MICHAEL C FLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 W 4700 S
TAYLORSVILLE UT
84129-3457
US

IV. Provider business mailing address

PO BOX 510708
SALT LAKE CITY UT
84151-0708
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-9200
  • Fax:
Mailing address:
  • Phone: 801-213-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5644084-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5644084-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: