Basic Information
| Provider Information | |||||||||
| NPI: | 1588603039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAEMISCH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ERNEST | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27128 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014088700 | ||||||||
| FaxNumber: | 8014088732 | ||||||||
| Practice Location | |||||||||
| Address1: | 324 10TH AVE | ||||||||
| Address2: | #100 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841032853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014088700 | ||||||||
| FaxNumber: | 8014088732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 60326411205 | UT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 2086S0105X | 6032641-1205 | UT | Y | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | 207XS0106X | 6032641-1205 | UT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 942854057012 | 05 | UT | MEDICAID |