Provider Demographics
NPI:1881629525
Name:GAREY, MICHAEL K (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:GAREY
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 1:560 S 300 E STE 275
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3586
Mailing Address - Country:US
Mailing Address - Phone:801-441-1002
Mailing Address - Fax:801-441-1002
Practice Address - Street 1:560 S 300 E STE 275
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3586
Practice Address - Country:US
Practice Address - Phone:801-441-1002
Practice Address - Fax:801-441-1002
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-55207P00000X, 207Q00000X
UT344862-1205207P00000X
NH14379207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT10162580Medicaid
NMZ2565OtherMEDICAID GROUP
NH30208587Medicaid
NM800521089OtherMEDICARE GROUP
NH001047001OtherMEDICARE B
NM1932187044OtherGROUP NPI
NMZ2565OtherMEDICAID GROUP