Individual
KEVIN BRANTLEY WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 E 3900 S STE 4E, MILLCREEK, UT 84124-1300
(385) 347-3773
Mailing address
1220 E 3900 S STE 4E, MILLCREEK, UT 84124-1343
(385) 347-3773
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
13005654-1205
UT
208600000X
Surgery Physician
55513
MN
2086S0102X
Surgical Critical Care Physician
13005654-1205
UT
2086S0127X
Trauma Surgery Physician
Q8190
TX
Other
Enumeration date
06/21/2011
Last updated
03/30/2023
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