Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11680858-1204 | UT |
Y | 207QS0010X | Family Doctor - Sports Medicine | 11680858-1204 | UT |
NPI | 1306378823 |
---|---|
Provider Name | Michael K Neilson |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Provo, UT 84604-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 27/07/2020 |