Search › Utah › 363LF0000X
Justin Illum
NPI 1265174452 · on the registry since 2022 · sole proprietor
Practice
- Address
- 971 E Creekhill Ln Apt 10
Midvale, UT 84047 - Phone
- (417) 693-3850
Registry record
- Primary taxonomy
- 363LF0000X
363LF0000X
- Also registered as
- 390200000X
- Licence states on file
- UT
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2024-12-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Utah