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NPI Code Detail

MEDICARE: WHOLE HEALTH MEDICAL GROUP

MEDICARE: WHOLE HEALTH MEDICAL GROUP
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
1174400000XSpecialistUT

General Provider Information

NPI Number : 1285011452
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHOLE HEALTH MEDICAL GROUP
Provider Business Mailing Address
First Line : 524 W 300 N STE 203
Second Line :
City : PROVO
State : UT
Zip : 84601-2669
Country : US
Telephone Number : 801-607-5270
Fax Number : 801-607-5271
Provider Business Practice Location Address
First Line : 524 W 300 N STE 203
Second Line :
City : PROVO
State : UT
Zip : 84601-2669
Country : US
Telephone Number : 801-607-5270
Fax Number : 801-607-5271
Authorized Official
Title or Position : OWNER
Name : DR. ANDREW D PETERSEN
Credential : D.O
Telephone Number : 801-607-5270
Provider Enumeration Date : 04/27/2015
Last Update Date : 07/21/2022

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Directions to “WHOLE HEALTH MEDICAL GROUP ” Practice Location

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