Provider Demographics
NPI:1639211972
Name:UROLOGY CLINIC OF UTAH VALLEY LLC
Entity Type:Organization
Organization Name:UROLOGY CLINIC OF UTAH VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:T
Authorized Official - Last Name:LANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-357-7530
Mailing Address - Street 1:1055 N 300 W
Mailing Address - Street 2:STE 316
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3344
Mailing Address - Country:US
Mailing Address - Phone:801-357-7530
Mailing Address - Fax:801-357-7566
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:STE 316
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3344
Practice Address - Country:US
Practice Address - Phone:801-357-7530
Practice Address - Fax:801-357-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty