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General NPI Number Information
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NPI Number | 1053993659
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Entity Type | Individual
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Provider Name | ELISE M. LE CAM MD
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Gender | Female
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | HELIX: 30 N MARIO CAPECCHI DR RM 3N100
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City | SALT LAKE CITY
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State | UT
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Zip | 84112-0001
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Country | US
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Telephone | 801-581-2121
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Fax | 801-581-7476
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Provider Business Mailing Address
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Address Line | HELIX: 30 N MARIO CAPECCHI DR RM 3N100
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City | SALT LAKE CITY
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State | UT
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Zip | 84112-0001
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Country | US
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Telephone | 801-581-2121
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Fax | 801-581-7476
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 14206550-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R78622
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License Number State | AZ
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