Individual
MIKE BURGGRAF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., L-ATC, EMT
Contact information
Practice address
495 S 100 E, MANTUA, UT 84324
(435) 720-1321
Mailing address
PO BOX 800, BRIGHAM CITY, UT 84302-0800
(435) 720-1321
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
070302009
UT
Other
Enumeration date
12/21/2015
Last updated
12/21/2015
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