Provider Demographics
NPI:1245222819
Name:SWINYARD, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:SWINYARD
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 1:1258 W S JORDAN PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4712
Mailing Address - Country:US
Mailing Address - Phone:801-838-9090
Mailing Address - Fax:801-838-9092
Practice Address - Street 1:1258 W SOUTH JORDAN PKWY STE 103
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4712
Practice Address - Country:US
Practice Address - Phone:801-838-9090
Practice Address - Fax:801-838-9092
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT292580-12052080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20000533Medicare PIN