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NPI Code Detail

MEDICARE: DR. MITCHELL R. KOLES PH.D.

MEDICARE:  DR. MITCHELL R. KOLES  PH.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
1103T00000XPsychologist116938-2501UT

General Provider Information

NPI Number : 1942365630
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MITCHELL R. KOLES PH.D.
Provider Business Mailing Address
First Line : 505 E 200 S
Second Line : SUITE 303
City : SALT LAKE CITY
State : UT
Zip : 84102-2022
Country : US
Telephone Number : 801-350-0121
Fax Number : 801-350-9582
Provider Business Practice Location Address
First Line : 505 E 200 S
Second Line : SUITE 303
City : SALT LAKE CITY
State : UT
Zip : 84102-2022
Country : US
Telephone Number : 801-350-0121
Fax Number : 801-350-9582
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/25/2006
Last Update Date : 07/09/2007

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Directions to “ DR. MITCHELL R. KOLES PH.D.” Practice Location

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