Provider Demographics
NPI:1467110833
Name:ATLAS INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:ATLAS INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLESEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-845-3736
Mailing Address - Street 1:8165 S WILLOW CREEK CV
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6203
Mailing Address - Country:US
Mailing Address - Phone:801-809-9471
Mailing Address - Fax:
Practice Address - Street 1:6965 S UNION PARK CTR STE 430
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84047-6507
Practice Address - Country:US
Practice Address - Phone:385-308-8937
Practice Address - Fax:801-701-8308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty