Healthcare Provider Details

I. General information

NPI: 1104875186
Provider Name (Legal Business Name): WILLIAM JOSEPH UTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 FRANCE AVE S SUITE 200
EDINA MN
55435-2148
US

IV. Provider business mailing address

6525 FRANCE AVE S SUITE 200
EDINA MN
55435-2148
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-6501
  • Fax: 952-653-1435
Mailing address:
  • Phone: 952-927-6501
  • Fax: 952-653-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number30044
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: