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General NPI Number Information
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NPI Number | 1861856510
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Entity Type | Individual
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Provider Name | MICHAEL D. GALLO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 395 W COUGAR BLVD
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City | PROVO
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State | UT
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Zip | 84604-3311
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Country | US
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Telephone | 801-357-7291
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Fax | 801-357-7919
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Provider Business Mailing Address
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Address Line | PO BOX 27128
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City | SALT LAKE CITY
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State | UT
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Zip | 84127-0128
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Country | US
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Telephone |
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Fax |
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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 | 207QS1201X
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Taxonomy Name | Sleep Medicine (Family Medicine) Physician
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License Number | ME158255
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QS1201X
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Taxonomy Name | Sleep Medicine (Family Medicine) Physician
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License Number | 14058793-1205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 207QS1201X
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Taxonomy Name | Sleep Medicine (Family Medicine) Physician
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License Number | 4301502051
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License Number State | MI
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