Individual
DR. IRENE KOCOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1000
Mailing address
2650 E 3300 S # CONDO5, SALT LAKE CITY, UT 84109-2711
(801) 884-6679
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
7153665-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7153665-8905
PHYSICIAN AND SURGEON
UT
Enumeration date
12/16/2008
Last updated
12/14/2021
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