Provider Demographics
NPI:1336192566
Name:SCHEULLER, MICHAEL COLEMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:COLEMAN
Last Name:SCHEULLER
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-2880
Mailing Address - Fax:801-387-2885
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:STE 2645
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3271
Practice Address - Country:US
Practice Address - Phone:801-387-2880
Practice Address - Fax:801-387-2885
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5592327-1205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057034Medicaid
UT942854057034Medicaid
UT000063511Medicare PIN
000059440Medicare PIN
UTH87734Medicare UPIN