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NPI Code Detail

MEDICARE: DR. JOHN EMIL WENNERGREN M.D.

MEDICARE: DR. JOHN EMIL WENNERGREN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician47353KY

General Provider Information

NPI Number : 1053545434
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN EMIL WENNERGREN M.D.
Provider Business Mailing Address
First Line : 3550 N UNIVERSITY AVE STE 250
Second Line :
City : PROVO
State : UT
Zip : 84604-6695
Country : US
Telephone Number : 801-374-9625
Fax Number :
Provider Business Practice Location Address
First Line : 3550 N UNIVERSITY AVE STE 250
Second Line :
City : PROVO
State : UT
Zip : 84604-6695
Country : US
Telephone Number : 801-374-9625
Fax Number : 801-374-9625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2009
Last Update Date : 03/13/2026

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Directions to “ DR. JOHN EMIL WENNERGREN M.D.” Practice Location

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