MEDICARE: AZIZA O KEVAL 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	207Q00000X	Family Medicine Physician	163276-1205	UT

General Provider Information

NPI Number	:	1790716439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZIZA O KEVAL M.D.

Provider Business Mailing Address
First Line	:	3665 S 8400 W
Second Line	:	SUITE 110
City	:	MAGNA
State	:	UT
Zip	:	84044-4907
Country	:	US
Telephone Number	:	801-250-9638
Fax Number	:	801-250-3204

Provider Business Practice Location Address
First Line	:	3665 S 8400 W
Second Line	:	SUITE 110
City	:	MAGNA
State	:	UT
Zip	:	84044-4907
Country	:	US
Telephone Number	:	801-250-9638
Fax Number	:	801-250-3204

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/15/2010

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