Provider Demographics
NPI:1669861902
Name:TAKMILI, PARVIZ
Entity Type:Individual
Prefix:
First Name:PARVIZ
Middle Name:
Last Name:TAKMILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 N 600 W APT 224
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-3728
Mailing Address - Country:US
Mailing Address - Phone:801-532-6666
Mailing Address - Fax:
Practice Address - Street 1:158 N 600 W APT 224
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-3728
Practice Address - Country:US
Practice Address - Phone:801-532-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter