Provider Demographics
NPI:1497412431
Name:UTAH STEM CELLS
Entity Type:Organization
Organization Name:UTAH STEM CELLS
Other - Org Name:UTAH STEM CELLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CIMIKOSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:801-651-1143
Mailing Address - Street 1:9035 S 700 E STE 200
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2412
Mailing Address - Country:US
Mailing Address - Phone:801-999-4860
Mailing Address - Fax:801-878-9717
Practice Address - Street 1:9035 S 700 E STE 200
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2412
Practice Address - Country:US
Practice Address - Phone:801-999-4860
Practice Address - Fax:801-878-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty