Healthcare Provider Details

I. General information

NPI: 1699410514
Provider Name (Legal Business Name): EMILIE LAURA UNGRICHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 S MARIO CAPECCHI DR
SALT LAKE CITY UT
84132-0005
US

IV. Provider business mailing address

UNIVERSITY OF UTAH 65 MARIO CAPPECHI DRI
SALT LAKE CITY UT
84132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2352
  • Fax:
Mailing address:
  • Phone: 801-581-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14278720-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: