Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dustin John Fanciullo, MD

Individual provider Surgery Physician · NPI 1013164052

Dustin John Fanciullo, MD is a Vascular Surgery in Salt Lake City, Utah. Graduated from University of Illinois College of Med (CHI/PEOR/ROCK/Chm-Urb) in 2004, 22 years ago. Practices with Mountainstar Cardiovascular Services LLC, a 14-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
22
Trained at
University of Illinois College of Med (CHI/PEOR/ROCK/Chm-Urb)
Licensed in
UT
In the registry since
2008
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1160 E 3900 S Ste 3100
Salt Lake City, UT 84124-1290
Phone: (801) 262-2806
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Vascular Surgery Physician (primary) Taxonomy 2086S0129X · Licence 14267138-1205 (UT)
Surgery Physician Taxonomy 208600000X · Licence 14267138-1205 (UT)

Record details

NPI number1013164052
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 21, 2008
Last updated in NPPESMarch 2, 2026
Certification dateMarch 2, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyVASCULAR SURGERY
Also practisesGENERAL SURGERY
Medical schoolUNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated 2004 (22 years in practice)
Group practice Mountainstar Cardiovascular Services Llc — 14 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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