| Utah Valley Diabetes Management Clinic | |
|
1134 N 500 W Ste 103 Provo UT 84604-6102 | |
| (801) 357-7546 | |
| (801) 357-7546 |
| Full Name | Utah Valley Diabetes Management Clinic |
|---|---|
| Speciality | Internal Medicine - Endocrinology, Diabetes & Metabolism |
| Location | 1134 N 500 W, Provo, Utah |
| Authorized Official Name and Position | Linda C Leckman (CEO INTERMOUNTAIN MEDICAL GROUP) |
| Authorized Official Contact | 8014423974 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Utah Valley Diabetes Management Clinic Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 357-7546 | Utah Valley Diabetes Management Clinic 1134 N 500 W Ste 103 Provo UT 84604-6102 Ph: (801) 357-7546 |
| NPI Number | 1659672459 |
|---|---|
| Provider Enumeration Date | 11/10/2010 |
| Last Update Date | 11/22/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659672459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 8862010 (Utah) | Primary |
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