Provider Demographics
NPI:1043390958
Name:DELANGE, MICHAEL DAYTON (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAYTON
Last Name:DELANGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-475-3500
Mailing Address - Fax:801-475-3414
Practice Address - Street 1:3225 W GORDON AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5728
Practice Address - Country:US
Practice Address - Phone:801-397-6150
Practice Address - Fax:801-397-6151
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70358207Q00000X
UT13150993-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A703580OtherINDIVIDUAL PROVIDER NUMBE
CA00A703580OtherINDIVIDUAL PROVIDER NUMBE
CAX74910Medicare UPIN
CAH64385Medicare UPIN
CA05D0598909Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER