Healthcare Provider Details

I. General information

NPI: 1437333895
Provider Name (Legal Business Name): INA AMBER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 E 3900 SO SUITE B275
SALT LAKE CITY UT
84124
US

IV. Provider business mailing address

1151 E 3900 SO SUITE B275
SALT LAKE CITY UT
84124
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-6830
  • Fax: 801-262-3584
Mailing address:
  • Phone: 801-268-6830
  • Fax: 801-262-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number1717901205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1717901205
License Number StateUT

VIII. Authorized Official

Name: INA J AMBER
Title or Position: MD PRIVATE PRACTICE
Credential: MD
Phone: 801-268-6830