Provider Demographics
NPI:1487765145
Name:ALVIN J WIRTHLIN MD PC
Entity type:Organization
Organization Name:ALVIN J WIRTHLIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIRTHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-364-0551
Mailing Address - Street 1:1500 ALTA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103
Mailing Address - Country:US
Mailing Address - Phone:801-364-0551
Mailing Address - Fax:
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:SUITE 228
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103
Practice Address - Country:US
Practice Address - Phone:801-364-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15501612052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870269232498Medicaid
UT870269232498Medicaid