Healthcare Provider Details

I. General information

NPI: 1689683435
Provider Name (Legal Business Name): J BRENT MUHLESTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST # L6
MURRAY UT
84107-5701
US

IV. Provider business mailing address

5121 S COTTONWOOD ST # L6
MURRAY UT
84107-5701
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-4760
  • Fax: 801-507-4792
Mailing address:
  • Phone: 801-507-4760
  • Fax: 801-507-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1878711205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: