Provider Demographics
NPI:1366331357
Name:UTAH INFECTIOUS DISEASE PLLC
Entity type:Organization
Organization Name:UTAH INFECTIOUS DISEASE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAWAD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:TANVIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-732-7226
Mailing Address - Street 1:11429 S 3100 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4957
Mailing Address - Country:US
Mailing Address - Phone:520-732-7226
Mailing Address - Fax:
Practice Address - Street 1:11429 S 3100 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4957
Practice Address - Country:US
Practice Address - Phone:520-732-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty