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General NPI Number Information
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NPI Number | 1902109549
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Entity Type | Organization
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Legal Business Name | BARIATRIC MEDICINE INSTITUTE
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 1046 E. 100 S.
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City | SALT LAKE CITY
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State | UT
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Zip | 84102
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Country | US
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Telephone | 801-746-2885
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Fax | 801-746-2886
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Provider Business Mailing Address
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Address Line | 1046 E. 100 S.
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City | SALT LAKE CITY
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State | UT
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Zip | 84102
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Country | US
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Telephone | 855-655-7389
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Fax | 801-931-2044
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DANIEL RHEAD COTTAM
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Credential |
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Telephone | 855-655-7389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 6655906-1205
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License Number State | UT
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