Provider Demographics
NPI:1336402569
Name:MECHAM, ELISE MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:MICHELLE
Last Name:MECHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N 1100 E STE A
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2910
Mailing Address - Country:US
Mailing Address - Phone:801-756-5600
Mailing Address - Fax:801-756-1787
Practice Address - Street 1:48 N 1100 E STE A
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2910
Practice Address - Country:US
Practice Address - Phone:801-756-5600
Practice Address - Fax:801-756-1787
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10043792208200000X
UT11163211-1205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery