NPI 1174062376 · live from the CMS NPI Registry
Dr. Brian Liljenquist PLLC
Clinic/Center, Multi-Specialty in Salt Lake City, UT. National Provider Identifier 1174062376, active.
NPI record
| NPI | 1174062376 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Clinic/Center, Multi-Specialty 261QM1300X |
| Practice location | 1250 E 3900 S Ste 440, Salt Lake City, UT 84124 |
| Practice phone | 801-869-4100 |
| Enumerated | February 21, 2017 |
| Last updated | June 16, 2018 |
| Authorized official | Brian Liljenquist, Managing Partner |
| Other names | Surgical Wound Care Associates; Elite Primary Care |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine | 207Q00000X | 9140789-1205 (UT) |
| Surgery | 208600000X | 8763069-1204 (UT) |
| Surgery, Trauma Surgery | 2086S0127X | 8763069-1204 (UT) |
| Podiatrist, Foot & Ankle Surgery | 213ES0103X | 83699990501 (UT) |
| Physical Therapist, Geriatrics | 2251G0304X | 292357-2401 (UT) |
| Clinic/Center, Multi-Specialty primary | 261QM1300X | 8763069-1204 (UT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.