MEDICARE: WASATCH GERIATRICS PC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	294016-2401	UT

General Provider Information

NPI Number	:	1619993276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASATCH GERIATRICS PC

Provider Business Mailing Address
First Line	:	2773 E ETIENNE WAY
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-1116
Country	:	US
Telephone Number	:	801-824-2748
Fax Number	:	801-272-4983

Provider Business Practice Location Address
First Line	:	1414 E 4500 S
Second Line	:	#1
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4228
Country	:	US
Telephone Number	:	801-272-0255
Fax Number	:	801-947-0840

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES STEVEN FEHLAUER
Credential	:	MD
Telephone Number	:	801-824-2748

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	04/22/2026

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