Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 1605921205 | UT |
N | 208600000X | Surgeon | 1605921205 | UT |
Y | 2086S0120X | Pediatric Surgery | 1605921205 | UT |
NPI | 1134200926 |
---|---|
Provider Name | Dr. Michael E Matlak |
First Address | Salt Lake City, UT 84113-1103 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 02/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05572 | (05) | UT |
C63464 | (02) | UT |