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General NPI Number Information
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NPI Number | 1336402569
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Entity Type | Individual
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Provider Name | ELISE MICHELLE MECHAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 48 N 1100 E STE A
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2910
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Country | US
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Telephone | 801-756-5600
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Fax | 801-756-1787
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Provider Business Mailing Address
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Address Line | 48 N 1100 E STE A
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2910
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Country | US
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Telephone | 801-756-5600
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Fax | 801-756-1787
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | BP10043792
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 11163211-1205
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License Number State | UT
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