Provider Demographics
NPI:1194102657
Name:SAGERS, KEVIN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL
Last Name:SAGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 W 9000 S STE 405
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5712
Mailing Address - Country:US
Mailing Address - Phone:801-568-3480
Mailing Address - Fax:
Practice Address - Street 1:3584 W 9000 S STE 405
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5712
Practice Address - Country:US
Practice Address - Phone:801-568-3480
Practice Address - Fax:801-568-3482
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12225026-1204207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty