Provider Demographics
NPI:1952755548
Name:VAN NORMAN, STEVEN BURKE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BURKE
Last Name:VAN NORMAN
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 1:5330 S 900 E STE 120
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3504
Mailing Address - Country:US
Mailing Address - Phone:801-266-0055
Mailing Address - Fax:801-266-0056
Practice Address - Street 1:5330 S 900 E STE 120
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-3504
Practice Address - Country:US
Practice Address - Phone:801-266-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
UT12687687-1205207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12687687-1205OtherPATHOLOGY-ANATOMIC/CLINICAL