Provider Demographics
NPI:1376688341
Name:GULSO PODIATRY, LLC
Entity Type:Organization
Organization Name:GULSO PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GULSO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-294-8266
Mailing Address - Street 1:415 MEDICAL DR
Mailing Address - Street 2:C200
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4946
Mailing Address - Country:US
Mailing Address - Phone:801-294-8266
Mailing Address - Fax:801-294-8265
Practice Address - Street 1:415 MEDICAL DR
Practice Address - Street 2:C200
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4946
Practice Address - Country:US
Practice Address - Phone:801-294-8266
Practice Address - Fax:801-294-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
6201940001Medicare NSC