Organization
UNIVERSITY OF UTAH PEDIATRIC PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANELL I MADONNA (DIRECTOR OF CONTRACTING AND PE)
(801) 587-6464
Entity
Organization
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2121
Mailing address
PO BOX 58049, SALT LAKE CITY, UT 84158-0049
(801) 581-7073
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
208600000X
Surgery Physician
—
—
Other
Enumeration date
08/07/2006
Last updated
04/14/2009
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