Basic Information
| Provider Information | |||||||||
| NPI: | 1215986484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALSOLAIMAN | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 N 500 W | ||||||||
| Address2: | CREDENTIALING DEPARTMENT | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013548225 | ||||||||
| FaxNumber: | 8014180941 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 E 50 S STE 221 | ||||||||
| Address2: | |||||||||
| City: | AMERICAN FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840032845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017720775 | ||||||||
| FaxNumber: | 8014180941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 55808791205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | P00132854 | 01 | UT | PALMETTO GBA | OTHER | 870281028000 | 05 | UT | MEDICAID | 107028412101 | 01 | UT | IHC HEALTHPLANS | OTHER | 214987 | 01 | UT | ALTIUS | OTHER | 870281028ALM | 01 | UT | EMIA | OTHER | 29-00138 | 01 | UT | UNITED HEALTHCARE | OTHER | 855086 | 01 | UT | DMBA | OTHER |