Healthcare Provider Details

I. General information

NPI: 1467765735
Provider Name (Legal Business Name): MALGORZATA HANCZYC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W SUITE 212
PROVO UT
84604-3305
US

IV. Provider business mailing address

1055 N 500 W
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-429-8095
  • Fax: 801-354-8265
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-429-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number7590776-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: