Healthcare Provider Details

I. General information

NPI: 1982970943
Provider Name (Legal Business Name): MICHELLE YANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE MAILSTOP 251SM4
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

3545 EASTWOOD DRIVE
SALT LAKE CITY UT
84109
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2700
  • Fax: 802-847-5626
Mailing address:
  • Phone: 734-604-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number10410183-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: