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NPI Code Detail

MEDICARE: DR. MICHAEL OWEN MEASOM M.D.

MEDICARE: DR. MICHAEL OWEN MEASOM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician264307-1205UT

General Provider Information

NPI Number : 1861479701
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL OWEN MEASOM M.D.
Provider Business Mailing Address
First Line : 265 E 100 S STE 250
Second Line :
City : SLC
State : UT
Zip : 84111-1643
Country : US
Telephone Number : 801-483-2447
Fax Number : 801-486-8705
Provider Business Practice Location Address
First Line : 265 E 100 S STE 250
Second Line :
City : SLC
State : UT
Zip : 84111-1643
Country : US
Telephone Number : 801-483-2447
Fax Number : 801-486-8705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 05/10/2018

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