Provider Demographics
NPI:1124296827
Name:PAUL PILGRAM M.D. P.C.
Entity type:Organization
Organization Name:PAUL PILGRAM M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PILGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-562-5300
Mailing Address - Street 1:8555 TOP OF THE WORLD CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6083
Mailing Address - Country:US
Mailing Address - Phone:801-562-5300
Mailing Address - Fax:801-562-1883
Practice Address - Street 1:1561 W 7000 S
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3556
Practice Address - Country:US
Practice Address - Phone:801-562-5300
Practice Address - Fax:801-562-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT167518-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD26553Medicare UPIN