Provider Demographics
NPI:1922115963
Name:UNIVERSITY OF UTAH PAIN MANAGEMENT PHYSICIANS GROUP
Entity Type:Organization
Organization Name:UNIVERSITY OF UTAH PAIN MANAGEMENT PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAHALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-581-6393
Mailing Address - Street 1:PO BOX 413034
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-3034
Mailing Address - Country:US
Mailing Address - Phone:801-213-3900
Mailing Address - Fax:
Practice Address - Street 1:546 S CHIPETA WAY
Practice Address - Street 2:220
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1221
Practice Address - Country:US
Practice Address - Phone:801-581-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502709OtherNEVADA MEDICAID
UT172970100OtherDEPT OF LABOR
WY122767000OtherWYOMING MEDICAID
ID806360300OtherIDAHO MEDICAID
ID806360300OtherIDAHO MEDICAID
UT172970100OtherDEPT OF LABOR