Healthcare Provider Details

I. General information

NPI: 1487584017
Provider Name (Legal Business Name): WILLOW GROVE MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15073 S ROUND TREE LN
DRAPER UT
84020-5509
US

IV. Provider business mailing address

152 W 620 S
OREM UT
84058-3125
US

V. Phone/Fax

Practice location:
  • Phone: 720-383-3555
  • Fax:
Mailing address:
  • Phone: 720-383-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC STEVENS
Title or Position: MANAGING MEMBER
Credential: DO
Phone: 720-383-3555