Provider Demographics
NPI:1649264763
Name:PODOLSKY, GILBERT (MD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:
Last Name:PODOLSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E 3900 S
Mailing Address - Street 2:SUITE 3F
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1327
Mailing Address - Country:US
Mailing Address - Phone:801-262-3354
Mailing Address - Fax:801-263-2922
Practice Address - Street 1:1220 E 3900 S
Practice Address - Street 2:SUITE 3F
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1327
Practice Address - Country:US
Practice Address - Phone:801-262-3354
Practice Address - Fax:801-263-2922
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1546091205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist