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

Dr. Michael Jonathan Carlson, MD

Individual provider Orthopaedic Surgery Physician · NPI 1407076193

Dr. Michael Jonathan Carlson, MD is an Orthopedic Surgery in Provo, Utah. Graduated from Medical College of Wisconsin in 2006, 20 years ago. Practices with Revere Health PC, a 410-clinician group and accepts Medicare assignment. Licensed in California, Nebraska and Utah.

Years since qualifying
20
Trained at
Medical College of Wisconsin
Licensed in
CA, NE, UT
In the registry since
2007
Specialties on file
3
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

1055 N 500 W Ste 121
Provo, UT 84604-3305
Phone: (801) 373-7350
Fax: (801) 812-5401
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthopaedic Surgery Physician (primary) Taxonomy 207X00000X · Licence 8283131-1205 (UT)
Orthopaedic Surgery Physician Taxonomy 207X00000X · Licence 5477 (NE)
Orthopaedic Surgery Physician Taxonomy 207X00000X · Licence A114736 (CA)

Record details

NPI number1407076193
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 26, 2007
Last updated in NPPESNovember 27, 2023
Certification dateAugust 25, 2020
Mailing address1055 N 500 W, Attn: Credentialing, Provo, UT 84604-3305

Medicare enrollment

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

Medicare specialtyORTHOPEDIC SURGERY
Medical schoolMEDICAL COLLEGE OF WISCONSIN
Graduated 2006 (20 years in practice)
Group practice Revere Health Pc — 410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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