MEDICARE: CYNTHIA LEE CARMACK MD

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	208000000X	Pediatrics Physician	87054171205	UT

General Provider Information

NPI Number	:	1548254360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LEE CARMACK MD

Provider Business Mailing Address
First Line	:	495 E 4500 S
Second Line	:	SUITE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2766
Country	:	US
Telephone Number	:	801-595-8844
Fax Number	:	801-506-0188

Provider Business Practice Location Address
First Line	:	495 E 4500 S
Second Line	:	SUITE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2766
Country	:	US
Telephone Number	:	801-595-8844
Fax Number	:	801-506-0188

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	11/26/2014

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