Organization
PEDIATRIC PM AND R
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIE P ELOVIC MD (CHAIR)
(801) 662-4949
Entity
Organization
Contact information
Practice address
100 MARIO CAPECCHI DR, ROOM 4400, SALT LAKE CITY, UT 84113-1103
(801) 662-4949
(801) 662-4931
Mailing address
PO BOX 413032, SALT LAKE CITY, UT 84141-3032
(801) 213-3900
(801) 585-3655
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
72775361205
UT
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
72775361205
UT
Other
Enumeration date
06/01/2011
Last updated
06/01/2011
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