Healthcare Provider Details

I. General information

NPI: 1821378704
Provider Name (Legal Business Name): LINDSAY JENNIFER MAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY JENNIFER MILES MD

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-3900
  • Fax:
Mailing address:
  • Phone: 650-839-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number9442921-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA117605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: