Healthcare Provider Details

I. General information

NPI: 1730911900
Provider Name (Legal Business Name): STEELEMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N 850 E STE A
LEHI UT
84043-8623
US

IV. Provider business mailing address

148 S 1100 E
AMERICAN FORK UT
84003-2817
US

V. Phone/Fax

Practice location:
  • Phone: 385-336-7461
  • Fax:
Mailing address:
  • Phone: 385-336-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: AJ YERGENSEN
Title or Position: ADMIN
Credential: MBA
Phone: 435-986-9369