Healthcare Provider Details

I. General information

NPI: 1427300177
Provider Name (Legal Business Name): INTERNAL MEDICINE-HEPATOLOGY- DEPARTMENT OF UNIVERSITY OF UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0100
US

IV. Provider business mailing address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0100
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6795
  • Fax: 801-581-7476
Mailing address:
  • Phone: 801-581-6795
  • Fax: 801-581-7476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number StateUT

VIII. Authorized Official

Name: DR. CURT H. HAGEDORN
Title or Position: DIVISION CHIEF
Credential: MD
Phone: 801-581-6795