MEDICARE: UNIVERSITY OF UTAH PAIN MANAGEMENT PHYSICIANS GROUP

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
1	207L00000X	Anesthesiology Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	172970100	OTHER	UT	DEPT OF LABOR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922115963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF UTAH PAIN MANAGEMENT PHYSICIANS GROUP

Provider Business Mailing Address
First Line	:	PO BOX 413034
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84141-3034
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	546 S CHIPETA WAY
Second Line	:	220
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1221
Country	:	US
Telephone Number	:	801-581-7172
Fax Number	:

Authorized Official
Title or Position	:	DEPARTMENT CHAIR
Name	:	MICHAEL K CAHALAN
Credential	:	MD
Telephone Number	:	801-581-6393

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	09/12/2013

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