Provider Demographics
NPI:1205215076
Name:UNIVERSITY OF UTAH
Entity Type:Organization
Organization Name:UNIVERSITY OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:POST-DOCTORAL RESEARCH FELLOW
Authorized Official - Prefix:
Authorized Official - First Name:MICHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BONIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:801-300-8926
Mailing Address - Street 1:1506 UNIVERSITY VLG APT 1506
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3522
Mailing Address - Country:US
Mailing Address - Phone:801-300-8926
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E # 4A100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:801-585-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital