Healthcare Provider Details

I. General information

NPI: 1356532576
Provider Name (Legal Business Name): WILLIAM JOHN CIMIKOSKI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 S. 300 W. SUITE #150
SANDY UT
84070
US

IV. Provider business mailing address

9980 S. 300 W. SUITE #150
SANDY UT
84070
US

V. Phone/Fax

Practice location:
  • Phone: 801-999-4860
  • Fax: 801-948-4120
Mailing address:
  • Phone: 801-999-4860
  • Fax: 801-948-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number316586-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberMD 429410
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number316586-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: