| Doctor Name: | DR. MARYAM REZVANI |
| NPI Number: | 1770701542 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 01060592A |
| Business Practice Address: | 30 North 1900 East #1a71 Salt Lake City, UT - 84132 |
| Business Phone Number: | 8015818699 |
| Business Fax Number: | 8015812414 |
| Mailing Address: | 30 N 1900 E, #1a71 SALT LAKE CITY |
| State: | UT |
| Postal Code: | 841322140 |
| Phone Number: | 8015817553 |
| Fax Number: | |
| NPI Enumeration Date: | 04/24/2007 |
| NPI Last Update Date: | 11/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | 01060592A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |