Provider Demographics
NPI:1124596192
Name:BILLAH, MUSLIMA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MUSLIMA
Middle Name:
Last Name:BILLAH
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 W BLACK ANGUS DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-1179
Mailing Address - Country:US
Mailing Address - Phone:801-916-5444
Mailing Address - Fax:
Practice Address - Street 1:HUNTSMAN CANCER INSTITUTE
Practice Address - Street 2:1950 CIRCLE OF HOPE DR.
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5500
Practice Address - Country:US
Practice Address - Phone:801-585-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10990500-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant