Provider Demographics
NPI:1629077979
Name:HANDLON, K MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:K
Middle Name:MICHAEL
Last Name:HANDLON
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 1:5444 S. GREEN ST.
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5632
Mailing Address - Country:US
Mailing Address - Phone:801-262-8120
Mailing Address - Fax:801-262-3897
Practice Address - Street 1:5444 S. GREEN ST.
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-5632
Practice Address - Country:US
Practice Address - Phone:801-262-8120
Practice Address - Fax:801-262-3897
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5120535-12052085R0202X
IDM-114932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505538Medicaid
ID807115700Medicaid
AZ923632Medicaid
UTP00651531OtherRR MEDICARE
WY120743100Medicaid
UTD4482Medicaid
UTP00199614OtherRR MEDICARE
ID807115700Medicaid
UT005790110Medicare PIN
UTD4482Medicaid