Provider Demographics
NPI:1790179786
Name:BISCHOFF, MICHELLE KATHRYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:KATHRYN
Last Name:BISCHOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:KATHRYN
Other - Last Name:BRUGGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:322 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2728
Mailing Address - Country:US
Mailing Address - Phone:610-751-2600
Mailing Address - Fax:
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3195
Practice Address - Country:US
Practice Address - Phone:801-387-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10117267-1205207RC0000X
UT10117267-8905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease