Provider Demographics
NPI:1538265947
Name:FARLEY, MICHAEL O (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:O
Last Name:FARLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:5121 S COTTONWOOD STREET
Practice Address - Street 2:INTERMOUNTAIN MEDICAL CENTER
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84157
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT170461-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT73594OtherPEHP
ID806754700Medicaid
UT107006501102OtherIHC
UT1502954OtherUMWA
UTPRA02713OtherMOLINA
UT468OtherHEALTHY U
UT2090168OtherUNITED HEALTHCARE
UT870545614FR2OtherEDUCATORS MUTUAL
NV100501998Medicaid
WY119269800Medicaid
UT20156OtherDESERET MUTUAL
UTQM0000075886OtherALTIUS
AZ833477Medicaid
WY119269800Medicaid
NV100501998Medicaid
UTD07591Medicare UPIN