Healthcare Provider Details

I. General information

NPI: 1073747887
Provider Name (Legal Business Name): SHANEEN UMAKANT DOCTOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF UTAH HOSPITAL 30 NORTH 1900 EAST
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

420 FLETCHER CT
SALT LAKE CITY UT
84102-3022
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2401
  • Fax:
Mailing address:
  • Phone: 503-490-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1073747887
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number39
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: