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General NPI Number Information
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NPI Number | 1477971232
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Entity Type | Individual
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Provider Name | NIKIL MOODABAGIL M.D., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2014
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Last Update Date | 04/17/2021
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Provider Practice Location Address
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Address Line | 4403 HARRISON BLVD STE 2855
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City | OGDEN
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State | UT
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Zip | 84403-3323
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Country | US
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Telephone | 801-387-7150
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Fax |
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Provider Business Mailing Address
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Address Line | 4403 HARRISON BLVD STE 2855
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City | OGDEN
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State | UT
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Zip | 84403-3323
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Country | US
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Telephone | 602-369-2191
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Fax |
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 12159845-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 12159845-1205
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License Number State | UT
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