Healthcare Provider Details

I. General information

NPI: 1437294253
Provider Name (Legal Business Name): SOUTH VALLEY RHEUMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11333 S 1000 E SUITE 100
SANDY UT
84094-5429
US

IV. Provider business mailing address

11333 S 1000 E SUITE 100
SANDY UT
84094-5429
US

V. Phone/Fax

Practice location:
  • Phone: 801-571-4100
  • Fax: 801-571-4125
Mailing address:
  • Phone: 801-571-4100
  • Fax: 801-571-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAX S LUNDBERG
Title or Position: PARTNER
Credential: MD
Phone: 801-571-4100