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NPI Code Detail

MEDICARE: DR. LELAND RUSSEL CHICK M.D.

MEDICARE: DR. LELAND RUSSEL CHICK 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
12086S0105XSurgery of the Hand (Surgery) Physician89-180960-1205UT
22086S0122XPlastic and Reconstructive Surgery Physician89-180960-1205UT

General Provider Information

NPI Number : 1912023383
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LELAND RUSSEL CHICK M.D.
Provider Business Mailing Address
First Line : 24 S 1100 E
Second Line : STE 201
City : SALT LAKE CITY
State : UT
Zip : 84102-1500
Country : US
Telephone Number : 801-322-1188
Fax Number : 801-363-1847
Provider Business Practice Location Address
First Line : 1220 E 3900 S STE 4I
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-1383
Country : US
Telephone Number : 801-322-1188
Fax Number : 801-363-1847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/21/2022

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