Individual
DR. KEVIN JOHN WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0100
(801) 585-7676
Mailing address
PO BOX 413033, SALT LAKE CITY, UT 84141-3033
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
364493-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
67850260
—
NM
05
—
952970
—
AZ
01
—
P00087033
RAILROAD MEDICARE
UT
Enumeration date
10/13/2006
Last updated
12/17/2021
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