Healthcare Provider Details

I. General information

NPI: 1316026883
Provider Name (Legal Business Name): NICOLE LENORE MIHALOPOULOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4578 S HIGHLAND DR STE 380
MILLCREEK UT
84117-4204
US

IV. Provider business mailing address

4107 E OAKVIEW DR
SALT LAKE CITY UT
84124-4043
US

V. Phone/Fax

Practice location:
  • Phone: 801-306-3632
  • Fax: 801-306-3633
Mailing address:
  • Phone: 801-306-3632
  • Fax: 801-306-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number5946961-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: