Healthcare Provider Details

I. General information

NPI: 1538698451
Provider Name (Legal Business Name): UTAH PODIATRIC PHYSICIANS AND SURGEONS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10290 N NORTH COUNTY BLVD STE 103
HIGHLAND UT
84003-6012
US

IV. Provider business mailing address

144 S 700 E
SALT LAKE CITY UT
84102-1357
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-1800
  • Fax:
Mailing address:
  • Phone: 801-532-1822
  • Fax: 801-527-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number7899779-0501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number7899779-0501
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number7899779-0501
License Number StateUT

VIII. Authorized Official

Name: LAURA DAY
Title or Position: CEO
Credential:
Phone: 515-867-0937