Provider Demographics
NPI:1093801151
Name:ALBRECHT, MITCHELL D (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:D
Last Name:ALBRECHT
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 1:2975 W EXECUTIVE PKWY
Mailing Address - Street 2:200
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1034 N 500 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84004
Practice Address - Country:US
Practice Address - Phone:801-993-9582
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT98-352896-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8130OtherHEALTHY U
UT343842OtherDESERET MUTUAL
AZ859605Medicaid
UTQM0000075886OtherALTIUS
UT870545614AL2OtherEDUCATORS MUTUAL
UTPRA02076OtherMOLINA
UT48253OtherPEHP
UT2090168OtherUNITED HEALTHCARE
UT8597445OtherWORKERS COMP
UT107006379101OtherIHC
UT1502954OtherUMWA
UT1502954OtherUMWA