Provider Demographics
NPI:1881670982
Name:PHILIPPI, DONNA KAY (DO)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:KAY
Last Name:PHILIPPI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E. 3300 S.
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106
Mailing Address - Country:US
Mailing Address - Phone:801-631-1624
Mailing Address - Fax:801-210-7426
Practice Address - Street 1:1550 E. 3300 S.
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-631-1624
Practice Address - Fax:801-210-7426
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT32334412042084P0800X
UT323344-12042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107012521101OtherINTERMOUNTAIN HEALTH CARE
UT341619OtherDESERET MUTUAL
UT942938348015OtherCHAMPUS
UT942938348PH1OtherEDUCATORS MUTUAL
UT003121007Medicare ID - Type UnspecifiedMEDICARE
UT003100001Medicare ID - Type UnspecifiedMEDICARE
UT942938348PH1OtherEDUCATORS MUTUAL
UT107012521101OtherINTERMOUNTAIN HEALTH CARE