Provider Demographics
NPI:1013149368
Name:VITEK, DAGMAR (MD, MPH)
Entity Type:Individual
Prefix:
First Name:DAGMAR
Middle Name:
Last Name:VITEK
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S. STATE ST.
Mailing Address - Street 2:SUITE S-2400
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84190-2150
Mailing Address - Country:US
Mailing Address - Phone:801-468-2805
Mailing Address - Fax:801-468-2825
Practice Address - Street 1:2001 S. STATE ST.
Practice Address - Street 2:SUITE S-2400
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84190-2150
Practice Address - Country:US
Practice Address - Phone:801-468-2805
Practice Address - Fax:801-468-2825
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174373-1205172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker