Basic Information
| Provider Information | |||||||||
| NPI: | 1467110833 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLAS INTERNAL MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8165 S WILLOW CREEK CV | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD HEIGHTS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840936203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018099471 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6965 S UNION PARK CTR STE 430 | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD HEIGHTS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840476507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3853088937 | ||||||||
| FaxNumber: | 8017018308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2021 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | WILLESEN | ||||||||
| AuthorizedOfficialFirstName: | KAVITA | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8018453736 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.