Provider Demographics
NPI:1285011452
Name:WHOLE HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:WHOLE HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-607-5270
Mailing Address - Street 1:524 W 300 N STE 203
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2669
Mailing Address - Country:US
Mailing Address - Phone:801-607-5270
Mailing Address - Fax:801-607-5271
Practice Address - Street 1:524 W 300 N STE 203
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2669
Practice Address - Country:US
Practice Address - Phone:801-607-5270
Practice Address - Fax:801-607-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty