Provider Demographics
NPI:1942881867
Name:PRESERVEMD LLC
Entity Type:Organization
Organization Name:PRESERVEMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:VAL
Authorized Official - Last Name:SUNDWALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-899-5410
Mailing Address - Street 1:835 S EAST MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1768
Mailing Address - Country:US
Mailing Address - Phone:801-899-5410
Mailing Address - Fax:
Practice Address - Street 1:10290 N. COUNTY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-899-5410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty