Individual
LOGAN KUPITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4095 E PONY EXPRESS PKWY STE 1, EAGLE MOUNTAIN, UT 84005-5531
(801) 429-8037
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11353339-1206
UT
Other
Enumeration date
08/30/2019
Last updated
05/13/2022
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