Provider Demographics
NPI:1093801151
Name:ALBRECHT, MITCHELL D (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:D
Last Name:ALBRECHT
Suffix:
Gender:
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 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1034 N 500 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84004
Practice Address - Country:US
Practice Address - Phone:801-993-9582
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND22124207L00000X
UT98-352896-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000075886OtherALTIUS
NV100503312Medicaid
UT343842OtherDESERET MUTUAL
UT107006379101OtherIHC
UT1502954OtherUMWA
UT48253OtherPEHP
UT870545614AL2OtherEDUCATORS MUTUAL
WY119681200Medicaid
UT8597445OtherWORKERS COMP
ID806156500Medicaid
UTPRA02076OtherMOLINA
UT2090168OtherUNITED HEALTHCARE
UT8130OtherHEALTHY U
AZ859605Medicaid