MEDICARE: DR. CHAD CHENOWETH M.D.

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	8436457-1205	UT

General Provider Information

NPI Number	:	1255620068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD CHENOWETH M.D.

Provider Business Mailing Address
First Line	:	1512 E 3115 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3456
Country	:	US
Telephone Number	:	801-205-4112
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 E 3115 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3456
Country	:	US
Telephone Number	:	801-205-4112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	01/19/2016

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