1164424750 NPI number — ADHISH K AGARWAL M.D.

Table of content: ADHISH K AGARWAL M.D. (NPI 1164424750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164424750 NPI number — ADHISH K AGARWAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGARWAL
Provider First Name:
ADHISH
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164424750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4403 HARRISON BLVD
Provider Second Line Business Mailing Address:
SUITE 2635
Provider Business Mailing Address City Name:
OGDEN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84403-3244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-387-6820
Provider Business Mailing Address Fax Number:
801-387-6825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4403 HARRISON BLVD
Provider Second Line Business Practice Location Address:
SUITE 2635
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84403-3244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-387-6820
Provider Business Practice Location Address Fax Number:
801-387-6825
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  4929797-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1164424750 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: D4939 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107018995101 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 3100065 . This is a "UHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870678603AKA . This is a "EMIA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 49297971200001 . This is a "HEALTHWISE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 49297971200001 . This is a "BXBS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 73351 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 110248797 . This is a "PALMETTO RR MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 119844100 . This is a "ACS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870678603 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000066341 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 800242 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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