Healthcare Provider Details

I. General information

NPI: 1730568445
Provider Name (Legal Business Name): AMERICAN FORK PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 N 1100 E SUITE C
AMERICAN FORK UT
84003-2910
US

IV. Provider business mailing address

48 N 1100 E SUITE C
AMERICAN FORK UT
84003-2910
US

V. Phone/Fax

Practice location:
  • Phone: 801-492-4333
  • Fax: 801-492-4371
Mailing address:
  • Phone: 801-492-4333
  • Fax: 801-492-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number168875-1205
License Number StateUT

VIII. Authorized Official

Name: MICHAEL D WHITING
Title or Position: OWNER
Credential: M.D.
Phone: 801-492-4333