Most Relevant Information
Provider Data
| NPI Number: | 1003656877 |
| Provider Name: | IGOR VIDOVIC |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/29/2024 |
| Last Updated: | 05/29/2024 |
Provider Practice Location
100 S 1000 W
TOOELE
UT
840744010
Practice Location Phone/Fax
| Phone: | 4358433520 |
| Fax: |
Provider Mailing Location
3725 W 4100 S STE 201
WEST VALLEY CITY
UT
841205427
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |