MEDICARE: ATLAS INTERNAL MEDICINE LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1467110833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS INTERNAL MEDICINE LLC

Provider Business Mailing Address
First Line	:	8165 S WILLOW CREEK CV
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84093-6203
Country	:	US
Telephone Number	:	801-809-9471
Fax Number	:

Provider Business Practice Location Address
First Line	:	6965 S UNION PARK CTR STE 430
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84047-6507
Country	:	US
Telephone Number	:	385-308-8937
Fax Number	:	801-701-8308

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KAVITA G WILLESEN
Credential	:	MD
Telephone Number	:	801-845-3736

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	07/11/2022

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