Individual
KARL N WEENIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N 500 W, SUITE 121, PROVO, UT 84604-3305
(801) 373-7350
(801) 812-5401
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
53765781205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870281028000
—
UT
01
—
870281028KNW
EMIA
UT
01
—
870281028KWF
EMIA
UT
01
—
89048
PEHP
UT
Enumeration date
04/04/2006
Last updated
11/27/2023
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