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Individual

MARK J CACCIAMANI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
466 E 500 S STE 200, SALT LAKE CITY, UT 84111-3350
(801) 485-5055
(801) 467-3296
Mailing address
522 E 100 S, SALT LAKE CITY, UT 84102-1905
(801) 485-5055
(801) 467-3296

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49426771205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000057838
PTAN
UT
05
D4498
UT
Enumeration date
10/11/2006
Last updated
08/19/2024
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