Healthcare Provider Details

I. General information

NPI: 1336496074
Provider Name (Legal Business Name): UNIVERSITY OF UTAH NEUROMUSCULAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N MEDICAL DRIVE
SALT LAKE CITY UT
84132-5901
US

IV. Provider business mailing address

PO BOX 413027
SALT LAKE CITY UT
84141-3027
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-7575
  • Fax:
Mailing address:
  • Phone: 801-213-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEFAN M PULST
Title or Position: DEPARTMENT CHAIR
Credential:
Phone: 801-585-6387