Healthcare Provider Details

I. General information

NPI: 1962331520
Provider Name (Legal Business Name): UTAH PODIATRY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 E PONY EXPRESS PKWY STE 140
EAGLE MOUNTAIN UT
84005-5548
US

IV. Provider business mailing address

3435 E PONY EXPRESS PKWY STE 140
EAGLE MOUNTAIN UT
84005-5548
US

V. Phone/Fax

Practice location:
  • Phone: 801-789-2444
  • Fax:
Mailing address:
  • Phone: 801-789-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER REYZELMAN
Title or Position: CMO
Credential: DPM
Phone: 415-292-0638