Healthcare Provider Details

I. General information

NPI: 1053263087
Provider Name (Legal Business Name): AMIT SURVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1046 E 100 S
SALT LAKE CITY UT
84102-1520
US

IV. Provider business mailing address

4582 W HARVEST SUN LN
SOUTH JORDAN UT
84009-4704
US

V. Phone/Fax

Practice location:
  • Phone: 801-746-2885
  • Fax:
Mailing address:
  • Phone: 801-746-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: