Individual
OLIVER BRANT NIKOLAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1160 E 3900 S STE 5000, SALT LAKE CITY, UT 84124-1275
(801) 261-7479
(801) 261-7429
Mailing address
PO BOX 100253, ATLANTA, GA 30384-0253
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2017-00543
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700149572
—
NC
01
—
2017-00543
MEDICAL LICENSE
NC
05
—
NC3023
—
SC
Enumeration date
06/18/2012
Last updated
01/25/2022
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