# INTERNAL MED-MICU/DEPARTMENT OF UNIVERSITY OF UTAH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457670788
- **Authorized official:** JANELL MADONNA (DIRECTOR)
- **Authorized official phone:** (801) 587-6464

## Contact information

- **Practice address:** 50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
- **Practice address phone:** (801) 581-2121
- **Mailing address:** PO BOX 413033, SALT LAKE CITY, UT 84141-3033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LC0200X | Critical Care Medicine Nurse Practitioner | — | NULL | — |
| 363LC0200X | Critical Care Medicine Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/26/2010
- **Last updated:** 05/26/2010