Whalio Doctors

NPI 1063665719

Michael Matthew Green, DO

Practitioner Pediatric Rehabilitation Medicine Physician Salt Lake City, UT

Practice location

Address
81 N Mario Capecchi Dr Department of Pediatrics, Salt Lake City, UT 84113-1125
Phone
(801) 213-7737
Fax
(801) 587-7539

Registered specialties (5)

Pediatric Rehabilitation Medicine Physician Primary
Allopathic & Osteopathic Physicians Taxonomy 2081P0010X Licence 8728465-1204 (UT)
Physical Medicine & Rehabilitation Physician
Allopathic & Osteopathic Physicians Taxonomy 208100000X Licence BP10031712 (TX)
Pediatric Rehabilitation Medicine Physician
Allopathic & Osteopathic Physicians Taxonomy 2081P0010X Licence 2011017820 (MO)
Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
Allopathic & Osteopathic Physicians Taxonomy 2081P0301X Licence 8728465-1204 (UT)
Student in an Organized Health Care Education/Training Program
Student, Health Care Taxonomy 390200000X

Registry record

NPI
1063665719
Entity type
Individual
Sex (as registered)
Male
NPI issued
28 Oct 2008
Record last updated
10 Dec 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.