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1871579920

NPI Code Detail

MEDICARE: TEELA SORENSEN MD

MEDICARE: TEELA SORENSEN MD

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	207V00000X	Obstetrics & Gynecology Physician	3713701205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005536827	OTHER	UT	MEDICARE #2
3	005701332	OTHER	UT	MEDICARE #3

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871579920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEELA SORENSEN MD

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-0337
Country	:	US
Telephone Number	:	801-773-4840
Fax Number	:	801-525-8151

Provider Business Practice Location Address
First Line	:	2038 W 1900 S
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075-9320
Country	:	US
Telephone Number	:	801-773-4840
Fax Number	:	801-525-8151

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/23/2012

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Directions to “ TEELA SORENSEN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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