Provider Demographics
NPI:1164424750
Name:AGARWAL, ADHISH K (MD)
Entity Type:Individual
Prefix:
First Name:ADHISH
Middle Name:K
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD
Mailing Address - Street 2:SUITE 2635
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3244
Mailing Address - Country:US
Mailing Address - Phone:801-387-6820
Mailing Address - Fax:801-387-6825
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:SUITE 2635
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3244
Practice Address - Country:US
Practice Address - Phone:801-387-6820
Practice Address - Fax:801-387-6825
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4929797-1205207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1164424750Medicaid
UTD4939Medicaid
UT107018995101OtherIHC
UT3100065OtherUHC
UT870678603AKAOtherEMIA
UT49297971200001OtherHEALTHWISE
UT49297971200001OtherBXBS
UT73351OtherPEHP
UT110248797OtherPALMETTO RR MEDICARE
UT119844100OtherACS
UT870678603OtherMOLINA
UTQM0000066341OtherALTIUS
UT800242OtherDMBA
UTQM0000066341OtherALTIUS
UT3100065OtherUHC