| NPI | 1659622033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SETH GLICKMAN Intrm Medical Group Pres/Cmo Cbc 801-442-2905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: UT 3622012) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: UT 362) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: UT 3622012) | |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2019-10-21 |