Provider Demographics
NPI:1386839579
Name:KEVIN K. PARZYCH, MD LLC
Entity Type:Organization
Organization Name:KEVIN K. PARZYCH, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARZYCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-892-0135
Mailing Address - Street 1:1151 E 3900 S
Mailing Address - Street 2:B299
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1216
Mailing Address - Country:US
Mailing Address - Phone:801-892-0135
Mailing Address - Fax:801-266-2362
Practice Address - Street 1:1151 E 3900 S
Practice Address - Street 2:B299
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1216
Practice Address - Country:US
Practice Address - Phone:801-892-0135
Practice Address - Fax:801-266-2362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEVIN K. PARZYCH, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-11
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG78781Medicare UPIN