Provider Demographics
NPI:1275613358
Name:CHANDLER, MICHAEL WARREN (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WARREN
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1380 EAST MEDICAL CENTER DRIVE
Practice Address - Street 2:DIXIE REGIONAL MEDICAL CENTER
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-251-1000
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT85-173262-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT25542OtherDESERET MUTUAL
ID806731900Medicaid
UT1502954OtherUMWA
AZ698912001Medicaid
UT37776OtherPEHP
UTQM0000075886OtherALTIUS
UT53228OtherHEALTHY U
WY118904200Medicaid
NV002082582Medicaid
UT107006554104OtherIHC
UT870545614CH4OtherEDUCATORS MUTUAL
UTPR00892OtherMOLINA
UT2090168OtherUNITED HEALTHCARE
UT050040816Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AZ698912001Medicaid
UTQM0000075886OtherALTIUS