MEDICARE: ALYSSA M. KREUTZJANS DO

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	208M00000X	Hospitalist Physician	13509659-1204	UT
2	208000000X	Pediatrics Physician	13509659-1204	UT

General Provider Information

NPI Number	:	1801546866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA M. KREUTZJANS DO

Provider Business Mailing Address
First Line	:	295 S CHIPETA WAY RM 2S010
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1287
Country	:	US
Telephone Number	:	801-581-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 S CHIPETA WAY RM 2S010
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1287
Country	:	US
Telephone Number	:	801-581-2121
Fax Number	:

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

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/09/2026

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