Healthcare Provider Details

I. General information

NPI: 1932051612
Provider Name (Legal Business Name): VEDRAN KNEZEVIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 W PALACE WAY
SALT LAKE CITY UT
84123-1213
US

IV. Provider business mailing address

1575 PALACE WAY
SALT LAKE CITY UT
84123
US

V. Phone/Fax

Practice location:
  • Phone: 385-542-1805
  • Fax:
Mailing address:
  • Phone: 385-542-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number2026002418
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: