Individual
MIKAELA DECOSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
30 N MARIO CAPECCHI DRIVE, SALT LAKE CITY, UT 84112
(801) 585-1618
Mailing address
30 N MARIO CAPECCHI DRIVE, SALT LAKE CITY, UT 84112
(801) 585-1618
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
14246130-1205
UT
Other
Enumeration date
03/26/2024
Last updated
11/06/2025
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