Basic Information
| Provider Information | |||||||||
| NPI: | 1144498163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKHTAR | ||||||||
| FirstName: | FAHEEM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5444 S GREEN STREET | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841235632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013134140 | ||||||||
| FaxNumber: | 7757897040 | ||||||||
| Practice Location | |||||||||
| Address1: | 3903 HARRISON BLVD. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844032361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013878900 | ||||||||
| FaxNumber: | 8013878920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2008 | ||||||||
| LastUpdateDate: | 02/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 6228774-8905 | UT | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 12869 | NV | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | FA0058873 | 01 | NV | DEA NUMBER | OTHER |