Healthcare Provider Details

I. General information

NPI: 1760713523
Provider Name (Legal Business Name): HEART AND LUNG INSTITUTE OF UTAH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 SO. FASHION BLVD
MURRAY UT
84107-7364
US

IV. Provider business mailing address

5979 S FASHION BLVD
MURRAY UT
84107-7364
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-2370
  • Fax: 801-265-1200
Mailing address:
  • Phone: 801-263-2370
  • Fax: 801-265-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TYLER R WILKO
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 801-263-2370