Provider Demographics
NPI:1861450140
Name:TWEDE, MICHAEL LAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAMAR
Last Name:TWEDE
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 1:10011 CENTENNIAL PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4156
Mailing Address - Country:US
Mailing Address - Phone:801-561-3922
Mailing Address - Fax:801-569-8710
Practice Address - Street 1:10011 CENTENNIAL PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4156
Practice Address - Country:US
Practice Address - Phone:801-561-3922
Practice Address - Fax:801-569-8710
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181357-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF29976Medicare UPIN
UT00010457Medicare ID - Type Unspecified