MEDICARE: UNIVERSITY OF UTAH NEUROMUSCULAR

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	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician

General Provider Information

NPI Number	:	1336496074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF UTAH NEUROMUSCULAR

Provider Business Mailing Address
First Line	:	PO BOX 413027
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84141-3027
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 N MEDICAL DRIVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-5901
Country	:	US
Telephone Number	:	801-585-7575
Fax Number	:

Authorized Official
Title or Position	:	DEPARTMENT CHAIR
Name	:	STEFAN M PULST
Credential	:
Telephone Number	:	801-585-6387

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	11/14/2012

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