Healthcare Provider Details

I. General information

NPI: 1194709956
Provider Name (Legal Business Name): SANJEEV BAKSHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 S 900 E STE 240
MURRAY UT
84117
US

IV. Provider business mailing address

PO BOX 3299
CARSON CITY NV
89702-3299
US

V. Phone/Fax

Practice location:
  • Phone: 801-783-5011
  • Fax: 801-746-3734
Mailing address:
  • Phone: 844-207-4039
  • Fax: 775-222-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8947
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD2018-0428
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number8947
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number9300195-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: