Provider Demographics
NPI:1356532576
Name:CIMIKOSKI, WILLIAM JOHN JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:CIMIKOSKI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10432 S WASATCH BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4555
Mailing Address - Country:US
Mailing Address - Phone:801-651-1143
Mailing Address - Fax:801-733-1987
Practice Address - Street 1:10432 S WASATCH BLVD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4555
Practice Address - Country:US
Practice Address - Phone:801-651-1143
Practice Address - Fax:801-733-1987
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 429410207PT0002X
UT316586-1205207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine