Provider Demographics
NPI:1851977862
Name:BISHOP, MICHAEL DALAN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DALAN
Last Name:BISHOP
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 1:4088 US HWY 91
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318
Mailing Address - Country:US
Mailing Address - Phone:435-563-4900
Mailing Address - Fax:435-563-4950
Practice Address - Street 1:4088 US HWY 91
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318
Practice Address - Country:US
Practice Address - Phone:435-563-4900
Practice Address - Fax:435-563-4950
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12931007-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine