Healthcare Provider Details

I. General information

NPI: 1447460274
Provider Name (Legal Business Name): AHMAD SAMI HALWANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEALTH INFORMATION DPT OF UTAH HOSPITAL 50 NORTH MEDICAL DRIVE, ROOM AA241 SOM
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

HEALTH INFORMATION DPT OF UTAH HOSPITAL 50 NORTH MEDICAL DRIVE, ROOM AA241 SOM
SALT LAKE CITY UT
84132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7907
  • Fax: 801-581-5393
Mailing address:
  • Phone: 801-581-7907
  • Fax: 801-581-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberR-8149
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR-7299
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberR-8589
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number8029607-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: