MEDICARE: SALT LAKE PODIATRY CENTER PLLC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	FP2145755	UT

General Provider Information

NPI Number	:	1437433422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALT LAKE PODIATRY CENTER PLLC

Provider Business Mailing Address
First Line	:	144 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1109
Country	:	US
Telephone Number	:	801-532-1822
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1109
Country	:	US
Telephone Number	:	801-532-1822
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. DANIEL L PREECE
Credential	:	DPM
Telephone Number	:	801-231-7410

Provider Enumeration Date	:	10/08/2011
Last Update Date	:	10/08/2011

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