Provider Demographics
NPI:1942402433
Name:MARION, MICHAEL DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:MARION
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 1:310 N 850 E STE A
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-8623
Mailing Address - Country:US
Mailing Address - Phone:801-331-8554
Mailing Address - Fax:801-341-8009
Practice Address - Street 1:310 N 850 E STE A
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-8623
Practice Address - Country:US
Practice Address - Phone:801-331-8554
Practice Address - Fax:801-341-8009
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50393208600000X
UT8217905-1205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery