MEDICARE: KINDLY MD, INC.

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1225647480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDLY MD, INC.

Provider Business Mailing Address
First Line	:	5097 S 900 E
Second Line	:
City	:	SALT LAKE CTY
State	:	UT
Zip	:	84117-5768
Country	:	US
Telephone Number	:	801-851-5554
Fax Number	:	833-464-2575

Provider Business Practice Location Address
First Line	:	5097 S 900 E STE 100
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-5725
Country	:	US
Telephone Number	:	801-851-5554
Fax Number	:	833-464-2575

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	AMY COWAN
Credential	:
Telephone Number	:	801-851-5554

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	08/24/2023

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