Provider Demographics
NPI:1225327927
Name:WEISCHEDEL, KAMILE M (MD)
Entity Type:Individual
Prefix:
First Name:KAMILE
Middle Name:M
Last Name:WEISCHEDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S CHIPETA WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1222
Mailing Address - Country:US
Mailing Address - Phone:801-581-4096
Mailing Address - Fax:801-581-5604
Practice Address - Street 1:127 S 500 E STE 600
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1971
Practice Address - Country:US
Practice Address - Phone:801-587-6336
Practice Address - Fax:801-715-8228
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8415776-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU23275740 02OtherCIGNA