Provider Demographics
NPI:1003306473
Name:SUNDWALL, PETER MICHAEL
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:SUNDWALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10290 N NORTH COUNTY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-8973
Mailing Address - Country:US
Mailing Address - Phone:801-899-3391
Mailing Address - Fax:801-685-3266
Practice Address - Street 1:10290 N. NORTH COUNTY BLVD. STE 200
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8400
Practice Address - Country:US
Practice Address - Phone:208-625-6000
Practice Address - Fax:208-625-6001
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12158239-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine