KELLY DAHLSTROM (NPI# 1134533417) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134533417 |
| Entity Type | Individual |
| Full Name | KELLY DAHLSTROM |
| Credential | D.O. |
| Practice Address |
30 N 1900 E Rm 1a071 Salt Lake City UT 84132-2140 |
| Practice Telephone | 8015817553 |
| Mailing Telephone | 8015817553 |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2020-05-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085N0700X |
Radiology Specialization: Neuroradiology |
11262272-1204 | UT | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
11262272-1204 | UT | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1500 S Main St, Fort Worth, TX 761044917 | 8177021255 |
| Street Address |
30 N 1900 E RM 1A071 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84132-2140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952697849 | Ashley D. Gettemy | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0002 | 2011-06-20 |
| 1619539749 | Blake A. Bartholomew | Internal Medicine | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0002 | 2019-06-28 |
| 1295393775 | Rishabh Agarwal | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0002 | 2019-05-30 |
| 1558925057 | Lauren B. Facer | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0001 | 2019-04-30 |
| 1801459037 | Samuel T. Keane | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0002 | 2019-04-14 |
| 1942763420 | Christopher M. Mallory | Internal Medicine | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0002 | 2019-04-10 |
| 1649732678 | Randy S. Brown | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0002 | 2019-03-31 |
| 1386104297 | Clifton Hartwell | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0002 | 2019-03-25 |
| 1568922151 | Alan R. Massouh | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-0002 | 2019-03-21 |
| 1033695994 | Anna Willis Hudson | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-2140 | 2018-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275162331 | Scott Andrew Rizzi | Student in an Organized Health Care Education/Training Program | 30 North 1900 East Som 4c116, Salt Lake City, UT 84132 | 2020-04-02 |
| 1609421403 | Monika Fleckenstein | Ophthalmology | 65 Mario Capecchi Drive, John A. Moran Eye Center, Salt Lake City, UT 84132 | 2019-08-08 |
| 1366975914 | Jacob Brandenburg | Anesthesiology | School of Medicine 30 North 1900 East Room 3c444, Salt Lake City, UT 84132 | 2017-04-10 |
| 1568815082 | Anastasia Neufeld | Ophthalmology | 65 Mario Capecchi Drive, Salt Lake City, UT 84132 | 2016-07-20 |
| 1912350083 | Gmaan Alzhrani | Student in an Organized Health Care Education/Training Program | 175 N. Medical Drive East , Salt Lake City, UT 84132 | 2016-07-13 |
| 1831544600 | Drew Goerke | Occupational Therapist | 50 N Medical Drive, Som Room #1r73, Salt Lake City, UT 84132 | 2016-04-29 |
| 1891179024 | Bong Jik Kim | Student in an Organized Health Care Education/Training Program | 50 North Medical Drive 3c120, Otolaryngology Administration Office, Salt Lake City, UT 84132 | 2015-07-17 |
| 1043699101 | Chris Anderson | Physician Assistant | 30 North 1900 East #3c344, Salt Lake City, UT 84132 | 2015-05-22 |
| 1689061822 | Ryan Clark | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 30 N 1900 E Som 3c127, Salt Lake City, UT 84132 | 2015-04-24 |
| 1649666264 | Kevin Conrad | Anesthesiology | 30 N 1900 E Room 3c444, Salt Lake City, UT 84132 | 2015-04-09 |
| Find all providers in zip 84132 | ||||
| Taxonomy Code | 2085N0700X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Neuroradiology |
| A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023317328 | Brad Wright | Radiology | 3321 S 3010 E, Salt Lake City, UT 84109-3170 | 2011-03-25 |
| 1780857490 | James Christopher Smith | Radiology | University of Utah -- Dept of Radiology-neuroradiology, 30 N, 1900 E -- 1a71, Salt Lake City, UT 84132-2140 | 2008-04-03 |
| 1902955255 | Lubdha M. Shah | Radiology | 30 N 1900 E Rm 1a71, Salt Lake City, UT 84132-0002 | 2007-01-09 |
| 1639564859 | Carrie Norris | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-2140 | 2015-04-03 |
| 1790104552 | Tyler Richards | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-2140 | 2014-04-09 |
| 1962829804 | Kalen Riley | Radiology | 30 N 1900 E Rm 1a071, Salt Lake City, UT 84132-2140 | 2014-03-27 |
| 1598846388 | Anne G. Osborn | Radiology | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2006-10-18 |
| 1922198555 | Edwin Arthur Stevens | Radiology | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2006-10-13 |
| 1003906629 | Karen Lisa Salzman | Radiology | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2006-10-13 |
| 1164512752 | Richard Henry Wiggins IIi | Radiology | 30 N 1900 E, #1a071; Department of Radiology, Salt Lake City, UT 84132-2140 | 2006-10-13 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84132 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.