Provider Demographics
NPI:1104289487
Name:KITCH, ALEC (MD)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:KITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 S WELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4121
Mailing Address - Country:US
Mailing Address - Phone:843-864-3808
Mailing Address - Fax:
Practice Address - Street 1:1250 E 3900 S
Practice Address - Street 2:SUITE #260 BR
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1348
Practice Address - Country:US
Practice Address - Phone:801-265-2000
Practice Address - Fax:801-265-2008
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-03
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10495139-8905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine