Basic Information
| Provider Information | |||||||||
| NPI: | 1013144450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLOUTZ | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 E CAMELBACK RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850182327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029331814 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 N MARIO CAPECCHI DR | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841131103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016621000 | ||||||||
| FaxNumber: | 0182137778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2009 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 128528 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2080P0202X | 11260386-8905 | UT | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 208000000X | 128528 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | 54407 | AZ | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No ID Information.