Individual
MICHAEL K NEILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
475 W 940 N, PROVO, UT 84604-3301
(801) 357-7871
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 357-7871
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
11680858-1204
UT
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
11680858-1204
UT
Other
Enumeration date
04/03/2017
Last updated
07/27/2020
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