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Individual

MICHAEL FANK JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
2504 S IMPERIAL ST, SALT LAKE CITY, UT 84106-3613
(251) 767-7880
Mailing address
2504 S IMPERIAL ST, SALT LAKE CITY, UT 84106-3613
(251) 767-7880

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
0103716
CO
208D00000X
General Practice Physician
Primary
11401847-4405
UT
208D00000X
General Practice Physician
13824
MN
208D00000X
General Practice Physician
226598
OK
208D00000X
General Practice Physician
277639
MT
208D00000X
General Practice Physician
334001
AZ
208D00000X
General Practice Physician
53-84973-081
KS
208D00000X
General Practice Physician
58177
WY
208D00000X
General Practice Physician
8771481
ID
208D00000X
General Practice Physician
896850
NV

Other

Enumeration date
10/23/2025
Last updated
02/03/2026
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