Healthcare Provider Details

I. General information

NPI: 1891906541
Provider Name (Legal Business Name): SUSAN ABU-KHALAF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 EAST 3900 SOUTH #200
SALT LAKE CITY UT
84107-2332
US

IV. Provider business mailing address

PO BOX 571800
MURRAY UT
84157-1800
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-2800
  • Fax: 801-747-3022
Mailing address:
  • Phone: 801-747-2800
  • Fax: 801-747-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number5747023-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: