Provider Demographics
NPI:1477971232
Name:MOODABAGIL, NIKIL (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:NIKIL
Middle Name:
Last Name:MOODABAGIL
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD STE 2855
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3323
Mailing Address - Country:US
Mailing Address - Phone:602-369-2191
Mailing Address - Fax:
Practice Address - Street 1:4403 HARRISON BLVD STE 2855
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3323
Practice Address - Country:US
Practice Address - Phone:801-387-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12159845-1205207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology