Organization
LAKEVIEW INTERNAL MEDICINE, LLC
Active
Other names
Lakeview Internal Medicine and Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM TEDRICK JOHNSON (GROUP VP/AO)
(615) 372-3375
Entity
Organization
Contact information
Practice address
444 W BOURNE CIR STE 101, FARMINGTON, UT 84025-3657
(801) 294-9333
(801) 294-7558
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4525
(615) 373-7406
(866) 346-1426
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518293323
—
UT
Enumeration date
10/29/2009
Last updated
08/29/2023
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