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Organization

MEDICAL DIRECTOR SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KAVITA G WILLESEN M.D. (PRESIDENT/PHYSICIAN)
(801) 809-9471
Entity
Organization

Contact information

Practice address
50 E 9000 S, SANDY, UT 84070-2201
(801) 561-9839
Mailing address
PO BOX 71840, SALT LAKE CITY, UT 84171-0840
(801) 809-9471
(801) 572-1497

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5049379-1205
UT

Other

Enumeration date
02/18/2008
Last updated
04/17/2008
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