MEDICARE: PEAK VASCULAR PROFESSIONALS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1063388346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK VASCULAR PROFESSIONALS

Provider Business Mailing Address
First Line	:	955 CHAMBERS ST STE 200
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-4519
Country	:	US
Telephone Number	:	801-252-6774
Fax Number	:	801-515-0165

Provider Business Practice Location Address
First Line	:	955 CHAMBERS ST STE 200
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-4519
Country	:	US
Telephone Number	:	801-441-9665
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SHAWN DALE ISAEFF
Credential	:	MD
Telephone Number	:	801-441-9665

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	12/29/2025

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