Healthcare Provider Details

I. General information

NPI: 1235559535
Provider Name (Legal Business Name): LAUREN LAHDAN SAEED HEIDARIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 1900 E SOM RM 4C116
SLC UT
84132
US

IV. Provider business mailing address

1774 S LAURELHURST DR
SLC UT
84108-3310
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-5559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number9538402-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: