MEDICARE: DR. GILBERT PODOLSKY M.D.

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	174400000X	Specialist	1546091205	UT

General Provider Information

NPI Number	:	1649264763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILBERT PODOLSKY M.D.

Provider Business Mailing Address
First Line	:	1220 E 3900 S
Second Line	:	SUITE 3F
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1327
Country	:	US
Telephone Number	:	801-262-3354
Fax Number	:	801-263-2922

Provider Business Practice Location Address
First Line	:	1220 E 3900 S
Second Line	:	SUITE 3F
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1327
Country	:	US
Telephone Number	:	801-262-3354
Fax Number	:	801-263-2922

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	07/08/2007

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