Basic Information
Provider Information
NPI: 1033558903
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AREINAMO
FirstName: IGOR
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 27128
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841270128
CountryCode: US
TelephoneNumber: 8014647788
FaxNumber:  
Practice Location
Address1: 2000 S 900 E
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841053208
CountryCode: US
TelephoneNumber: 8014647788
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/24/2013
LastUpdateDate: 05/09/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X9712506-1205UTY Allopathic & Osteopathic PhysiciansPediatrics 
208000000X6266GAN Allopathic & Osteopathic PhysiciansPediatrics 
2080P0202X9712506-8905UTN Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology

No ID Information.


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