Provider Demographics
NPI:1588603039
Name:RAEMISCH, MICHAEL ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERNEST
Last Name:RAEMISCH
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-8700
Mailing Address - Fax:801-408-8732
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:#100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-408-8700
Practice Address - Fax:801-408-8732
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60326411205207X00000X
UT6032641-12052086S0105X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057012Medicaid
NVH75091Medicare UPIN
UT000062339Medicare PIN
UT942854057012Medicaid
UT000063479Medicare PIN
UT000060076Medicare PIN