Individual
MICHAEL WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
220 MILLPOND STE 100, STANSBURY PARK, UT 84074-9760
(435) 843-3000
(435) 843-3015
Mailing address
220 MILLPOND STE 100, STANSBURY PARK, UT 84074-9760
(435) 843-3000
(435) 843-3015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7546357-1205
UT
207Q00000X
Family Medicine Physician
RL16538
ND
208D00000X
General Practice Physician
7546357-1205
UT
Other
Enumeration date
09/25/2019
Last updated
11/23/2023
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