Provider Demographics
NPI:1386855708
Name:BOVOS, MIKE ELIAS (MD)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:ELIAS
Last Name:BOVOS
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 1:1250 EAST 3900 SOUTH
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1371
Mailing Address - Country:US
Mailing Address - Phone:801-265-2000
Mailing Address - Fax:801-265-2008
Practice Address - Street 1:1250 E 3900 S
Practice Address - Street 2:SUITE 260
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1348
Practice Address - Country:US
Practice Address - Phone:801-265-2000
Practice Address - Fax:801-265-2008
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT285706-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine