Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 11262384-1204 | UT |
NPI | 1073956793 |
---|---|
Provider Name | Dr. Ian Schlieder |
First Address | Salt Lake City, UT 84132-0002 |
Second Address | Salt Lake City, UT 84132-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2013 |
Last Update Date | 12/06/2019 |