Provider Demographics
NPI:1548244676
Name:SONI, POONAM (MD)
Entity Type:Individual
Prefix:DR
First Name:POONAM
Middle Name:
Last Name:SONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:P
Other - Middle Name:
Other - Last Name:SONI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1399 S 700 E STE 17B
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2149
Mailing Address - Country:US
Mailing Address - Phone:801-558-4511
Mailing Address - Fax:
Practice Address - Street 1:1399 S 700 E STE 17B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2149
Practice Address - Country:US
Practice Address - Phone:801-558-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176957-12052084F0202X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT002200036Medicare PIN
UT002200036Medicare ID - Type Unspecified
UTE27837Medicare UPIN
UTU000074793Medicare PIN
UTU000073848Medicare PIN
UTU000073679Medicare PIN
UT008101017Medicare ID - Type UnspecifiedINDIV. MEDICARE ID
UT00 2200189Medicare PIN
UTE27837Medicare UPIN
UT107006891102OtherIHC/HEALTH CHOICE
UT870293014PONOtherEMIA
UT260048329OtherRAILROAD MEDICARE
UT107006891101OtherINTERMOUNTAIN HEALTH CARE
UT870443046OtherCHAMPUS
UTU000073848Medicare PIN
UTU000074793Medicare PIN
UTU000073679Medicare PIN
UT158629OtherDESERET MUTUAL
UT008101017Medicare ID - Type UnspecifiedINDIV. MEDICARE ID
UT00 2200189Medicare PIN