Provider Demographics
NPI:1063388346
Name:PEAK VASCULAR PROFESSIONALS
Entity type:Organization
Organization Name:PEAK VASCULAR PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ISAEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-441-9665
Mailing Address - Street 1:1541 WASATCH DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1422
Mailing Address - Country:US
Mailing Address - Phone:801-441-9665
Mailing Address - Fax:
Practice Address - Street 1:955 CHAMBERS ST STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4519
Practice Address - Country:US
Practice Address - Phone:801-441-9665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty