Individual
MICHAELA ANTJE SQUIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
81 N MARIO CAPECCHI DR RM 4B096, SALT LAKE CITY, UT 84113-1125
(801) 581-2121
Mailing address
81 N MARIO CAPECCHI DR RM 4B096, SALT LAKE CITY, UT 84113-1125
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
Primary
14212907-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
261938
NC
Other
Enumeration date
05/04/2020
Last updated
03/24/2025
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