Provider Demographics
NPI:1205208691
Name:WILLIAM CIMIKOSKI MD, LLC
Entity Type:Organization
Organization Name:WILLIAM CIMIKOSKI MD, LLC
Other - Org Name:UTAH STEM CELLS JOINT TREATMENT AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CIMIKOSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:801-651-1143
Mailing Address - Street 1:7430 S CREEK RD
Mailing Address - Street 2:#104
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6158
Mailing Address - Country:US
Mailing Address - Phone:801-981-8795
Mailing Address - Fax:801-987-8051
Practice Address - Street 1:7430 S CREEK RD
Practice Address - Street 2:#104
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6158
Practice Address - Country:US
Practice Address - Phone:801-981-8795
Practice Address - Fax:801-987-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT316586-1205261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service