Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Michael C. Wallis, MD

Individual provider Pediatric Urology Physician · NPI 1558384388

Dr. Michael C. Wallis, MD is an Urology in Salt Lake City, Utah. Graduated from Ohio State University College of Medicine in 1999, 27 years ago. Practices with University of Utah Pediatric Services, a 119-clinician group and accepts Medicare assignment. Licensed in Idaho and Utah.

Years since qualifying
27
Trained at
Ohio State University College of Medicine
Licensed in
ID, UT
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

100 Mario Capecchi Dr
Salt Lake City, UT 84113-1103
Phone: (801) 662-5555
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Urology Physician (primary) Taxonomy 208800000X · Licence 6078212-1205 (UT)
Pediatric Urology Physician Taxonomy 2088P0231X · Licence M-13870 (ID)

Record details

NPI number1558384388
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 25, 2006
Last updated in NPPESDecember 16, 2021
Certification dateDecember 16, 2021
Mailing addressPo Box 413035, Salt Lake City, UT 84141-3035

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyUROLOGY
Also practisesPEDIATRIC MEDICINE
Medical schoolOHIO STATE UNIVERSITY COLLEGE OF MEDICINE
Graduated 1999 (27 years in practice)
Group practice University Of Utah Pediatric Services — 119 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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