Provider Demographics
NPI:1477849123
Name:SORWEID, MICHELLE R (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:SORWEID
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DIVISION OF GERIATRICS SCHOOL OF MEDICINE
Mailing Address - Street 2:30 N 1900 E, ROOM AB193
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-587-9103
Mailing Address - Fax:
Practice Address - Street 1:DIVISION OF GERIATRICS SCHOOL OF MEDICINE
Practice Address - Street 2:30 N 1900 E, ROOM AB193
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-587-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT90063931204207RG0300X
UT9006393-1204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine