Individual
DR. MICHAEL MATTHEW GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
81 N MARIO CAPECCHI DR, DEPARTMENT OF PEDIATRICS, SALT LAKE CITY, UT 84113-1125
(801) 213-7737
(801) 587-7539
Mailing address
81 N MARIO CAPECCHI DR, DEPARTMENT OF PEDIATRICS, SALT LAKE CITY, UT 84113-1125
(801) 213-7737
(801) 587-7539
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
BP10031712
TX
2081P0010X
Pediatric Rehabilitation Medicine Physician
2011017820
MO
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
8728465-1204
UT
2081P0301X
Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
8728465-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/28/2008
Last updated
12/10/2021
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