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General NPI Number Information
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NPI Number | 1750734232
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Entity Type | Organization
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Legal Business Name | PUSH CONCIERGE MEDICINE, PLLC
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 01/26/2025
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Provider Practice Location Address
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Address Line | 50 W BROADWAY STE 333 #164321
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City | SALT LAKE CITY
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State | UT
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Zip | 84101-2027
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Country | US
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Telephone | 801-709-1470
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Fax | 253-218-6964
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Provider Business Mailing Address
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Address Line | 50 W BROADWAY STE 333 #164321
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City | SALT LAKE CITY
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State | UT
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Zip | 84101-2027
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Country | US
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Telephone | 801-709-1470
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Fax | 253-218-6964
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MARSHALL NICKEL
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Credential | MD
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Telephone | 253-985-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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