Individual
DANA BOUCEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 NORTH MARIO CAPECCHI DR., PRIMARY CHILDREN'S, SALT LAKE CITY, UT 84113
(801) 662-5700
Mailing address
3601 MARKET ST UNIT 1713, PHILADELPHIA, PA 19104-5914
(303) 746-7692
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
MD460722
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/26/2011
Last updated
10/28/2021
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