Provider Demographics
NPI:1427161363
Name:VIZMEG, KARL K (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:K
Last Name:VIZMEG
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:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-1098
Mailing Address - Country:US
Mailing Address - Phone:801-423-3306
Mailing Address - Fax:801-423-3309
Practice Address - Street 1:1000 E 100 N
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1600
Practice Address - Country:US
Practice Address - Phone:801-465-7190
Practice Address - Fax:801-423-3309
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT322096-8905146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD1539Medicaid
UTD1539Medicaid