Healthcare Provider Details

I. General information

NPI: 1558868976
Provider Name (Legal Business Name): KEVIN MICHAEL BROWN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 MEDICAL DR STE 100
BOUNTIFUL UT
84010-4928
US

IV. Provider business mailing address

470 MEDICAL DR STE 100
BOUNTIFUL UT
84010-4928
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-1464
  • Fax: 801-292-1465
Mailing address:
  • Phone: 801-292-1464
  • Fax: 801-292-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number72639-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: