Individual
REE LU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 N MARIO CAPECCHI DR, RM 3N100, SALT LAKE CITY, UT 84112
(801) 581-2121
Mailing address
30 N MARIO CAPECCHI DR, RM 3N100, SALT LAKE CITY, UT 84112
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
14215299-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/21/2022
Last updated
04/15/2025
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