=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558868976
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN MICHAEL BROWN DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2018
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 470 MEDICAL DR STE 100
-----------------------------------------------------
City | BOUNTIFUL
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84010-4928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-292-1464
-----------------------------------------------------
Fax | 801-292-1465
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 470 MEDICAL DR STE 100
-----------------------------------------------------
City | BOUNTIFUL
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84010-4928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-292-1464
-----------------------------------------------------
Fax | 801-292-1465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 72639-21
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------