Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 322409-1204 | UT |
NPI | 1174136113 |
---|---|
Provider Name | Amir Haskic |
First Address | Salt Lake City, UT 84109-2821 |
Second Address | Salt Lake City, UT 84109-2821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |