Healthcare Provider Details

I. General information

NPI: 1326159427
Provider Name (Legal Business Name): KRISTINE M ZELENKOV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 HARRISON BLVD SUITE 4650
OGDEN UT
84403-3294
US

IV. Provider business mailing address

4650 HARRISON BLVD
OGDEN UT
84403-4303
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-3240
  • Fax: 801-475-3241
Mailing address:
  • Phone: 801-475-3000
  • Fax: 801-475-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number49109541205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: