Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Brant Wahlen Fonnesbeck, DO

Individual provider Family Medicine Physician · NPI 1033156849

Brant Wahlen Fonnesbeck, DO is a Family Practice in Logan, Utah. Graduated from At Still University of Health Sciences, College of Osteo Med, Kirksville in 2004, 22 years ago. Practices with Ihc Health Services Inc, a 3,947-clinician group. Licensed in Utah.

Years since qualifying
22
Trained at
At Still University of Health Sciences, College of Osteo Med, Kirksville
Licensed in
UT
In the registry since
2006
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

550 E 1400 N Ste K
Logan, UT 84341-2450
Phone: (435) 755-6061
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 5953772-1204 (UT)

Record details

NPI number1033156849
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedJune 1, 2006
Last updated in NPPESFebruary 26, 2008

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolAT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
Graduated 2004 (22 years in practice)
Group practice Ihc Health Services Inc — 3947 clinicians
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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