Provider Demographics
NPI:1144498163
Name:AKHTAR, FAHEEM (MD)
Entity type:Individual
Prefix:
First Name:FAHEEM
Middle Name:
Last Name:AKHTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5444 S GREEN STREET
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5632
Mailing Address - Country:US
Mailing Address - Phone:801-313-4140
Mailing Address - Fax:775-789-7040
Practice Address - Street 1:3903 HARRISON BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2361
Practice Address - Country:US
Practice Address - Phone:801-387-8900
Practice Address - Fax:801-387-8920
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6228774-89052086S0129X
NV128692086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFA0058873OtherDEA NUMBER
NVFA0058873OtherDEA NUMBER