Individual
MICHAEL TRAVIS IVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4403 HARRISON BLVD STE 700A, OGDEN, UT 84403-3295
(801) 387-5300
(801) 387-5333
Mailing address
1149 23RD ST, OGDEN, UT 84401-1906
(801) 687-8510
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12382175-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
03/27/2020
Last updated
04/13/2023
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