Provider Demographics
NPI:1902109549
Name:BARIATRIC MEDICINE INSTITUTE
Entity Type:Organization
Organization Name:BARIATRIC MEDICINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RHEAD
Authorized Official - Last Name:COTTAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-655-7389
Mailing Address - Street 1:1046 E. 100 S.
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102
Mailing Address - Country:US
Mailing Address - Phone:855-655-7389
Mailing Address - Fax:801-931-2044
Practice Address - Street 1:1046 E. 100 S.
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:801-746-2885
Practice Address - Fax:801-746-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6655906-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty