MEDICARE: PATRICK CORDES

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	171M00000X	Case Manager/Care Coordinator		UT

General Provider Information

NPI Number	:	1669848719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK CORDES

Provider Business Mailing Address
First Line	:	1522 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2425
Country	:	US
Telephone Number	:	801-467-1200
Fax Number	:	801-467-1210

Provider Business Practice Location Address
First Line	:	1522 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2425
Country	:	US
Telephone Number	:	801-467-1200
Fax Number	:	801-467-1210

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

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	08/12/2015

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Directions to “ PATRICK CORDES ” Practice Location

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