MEDICARE: UTAH PODIATRY GROUP LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1841129327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTAH PODIATRY GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 849795
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-9795
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 E MURRAY HOLLADAY RD STE 102
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4961
Country	:	US
Telephone Number	:	801-274-9060
Fax Number	:

Authorized Official
Title or Position	:	CMO
Name	:	ALEXANDER REYZELMAN
Credential	:	DPM
Telephone Number	:	415-292-0638

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “UTAH PODIATRY GROUP LLC ” Practice Location

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