Provider Demographics
NPI:1629063755
Name:CODY, MICHAEL C (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:CODY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:520 MEDICAL DR
Mailing Address - Street 2:SUITE #310
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4968
Mailing Address - Country:US
Mailing Address - Phone:801-397-3000
Mailing Address - Fax:801-397-0455
Practice Address - Street 1:2132 NORTH 1700 WEST
Practice Address - Street 2:SUITE #200
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1130
Practice Address - Country:US
Practice Address - Phone:801-776-0174
Practice Address - Fax:801-825-3904
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-09-26
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Provider Licenses
StateLicense IDTaxonomies
UT327424-1205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1477643179OtherGROUP NPI
UTG33383Medicare UPIN