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Individual

MIKHAIL SHIPOTKO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4401 HARRISON BLVD, OGDEN, UT 84403-3195
(801) 387-2800
Mailing address
4401 HARRISON BLVD, OGDEN, UT 84403-3195
(801) 387-2800

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R2744
TX
208M00000X
Hospitalist Physician
Primary
13523114-1235
UT
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
370615201
TX
Enumeration date
09/10/2014
Last updated
06/05/2024
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