MEDICARE: DR. CHARLES M. ARENA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	171559-1205	UT

General Provider Information

NPI Number	:	1164664637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES M. ARENA M.D.

Provider Business Mailing Address
First Line	:	6065 FASHION BLVD
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-7381
Country	:	US
Telephone Number	:	801-268-1610
Fax Number	:	801-268-1221

Provider Business Practice Location Address
First Line	:	6065 FASHION BLVD
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-7381
Country	:	US
Telephone Number	:	801-268-1610
Fax Number	:	801-268-1221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	03/30/2009

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