Presidium Medical Group PLLC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

Legal business name

PRESIDIUM MEDICAL GROUP PLLC

Practice address

32 E Exchange PL FL 6
Salt Lake City, UT 84111-2704

Phone

(619) 738-5566

NPI assigned

Apr 22, 2025

Last updated

Apr 22, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ashkan Hayatdavoudi, MD

Title

Owner

Phone

(619) 738-5566

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1689461774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 E EXCHANGE PL FL 6",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841112704",
            "telephone_number": "619-738-5566",
            "fax_number": "619-566-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 E EXCHANGE PL FL 6",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841112704",
            "telephone_number": "619-738-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESIDIUM MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-22",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "HAYATDAVOUDI",
        "authorized_official_first_name": "ASHKAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-738-5566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Adult Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.