Active NPI
Michael T. Bounajem, MD
- Neurological Surgery Physician
- Salt Lake City, UT
National Provider Identifier
1093343527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- License
- 12439568-1205
- Practice address
- 175 N Medical Dr E #5
Salt Lake City, UT 84132-0001 - Phone
- (801) 581-6908
- NPI assigned
- Mar 30, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | 12439568-1205 | UT | Primary |
Addresses
Primary practice location
175 N Medical Dr E #5
Salt Lake City, UT 84132-0001
Mailing address
175 N Medical Dr E #5
Salt Lake City, UT 84132-0001
Phone (801) 581-6908
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12439568-1205 | UT | MD | Neurological Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631836800000",
"number": "1093343527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 N MEDICAL DR E #5",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841320001",
"telephone_number": "801-581-6908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 N MEDICAL DR E #5",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841320001",
"telephone_number": "801-581-6908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUNAJEM",
"first_name": "MICHAEL",
"middle_name": "T.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-30",
"last_updated": "2021-09-17",
"certification_date": "2021-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "",
"desc": "Neurological Surgery",
"state": "UT",
"license": "12439568-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.