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General NPI Number Information
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NPI Number | 1316834054
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Entity Type | Organization
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Legal Business Name | CARDIORENAL VISION OF UTAH PLLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 794 S WEST HOYTSVILLE RD
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City | COALVILLE
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State | UT
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Zip | 84017-9761
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Country | US
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Telephone | 815-677-2161
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 516
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City | OREGON
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State | IL
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Zip | 61061-0516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | KRISTIN OBRIEN
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Credential |
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Telephone | 815-677-2161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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