Provider Demographics
NPI:1356573257
Name:CALL, MICHAEL D (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:CALL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 ROUND VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7064
Mailing Address - Country:US
Mailing Address - Phone:435-658-1116
Mailing Address - Fax:
Practice Address - Street 1:3144 ROUND VALLEY WAY
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7064
Practice Address - Country:US
Practice Address - Phone:435-658-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT187982-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered