Organization
UNIVERSITY OF UTAH PEDIATRIC SURGEONS
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
100 MARIO CAPECCHI DR, SUITE 2600, SALT LAKE CITY, UT 84113-1103
(801) 662-2950
Mailing address
100 MARIO CAPECCHI DR, SUITE 2600, SALT LAKE CITY, UT 84113-1103
(801) 662-0250
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
2086S0120X
Pediatric Surgery Physician
Primary
—
—
Other
Enumeration date
08/07/2006
Last updated
04/14/2009
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