Basic Information
| Provider Information | |||||||||
| NPI: | 1255502217 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIRSHBERG | ||||||||
| FirstName: | ELIOTTE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HIRSHBERG | ||||||||
| OtherFirstName: | ELLIE | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 27128 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014421400 | ||||||||
| FaxNumber: | 8014420653 | ||||||||
| Practice Location | |||||||||
| Address1: | 5121 COTTONWOOD ST | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015077000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 09/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 5384844-8905 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 2080P0203X | 5384844-8905 | UT | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 207R00000X | 5384844-1205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.