Healthcare Provider Details

I. General information

NPI: 1891601191
Provider Name (Legal Business Name): UTAH PODIATRY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N 400 W
SALT LAKE CITY UT
84103-3774
US

IV. Provider business mailing address

PO BOX 849795
LOS ANGELES CA
90084-9795
US

V. Phone/Fax

Practice location:
  • Phone: 801-532-1822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER REYZELMAN
Title or Position: CMO
Credential:
Phone: 415-292-0638