1659334282 NPI number — DR. BRADLEY H KOFFMAN MD

Table of content: DR. BRADLEY H KOFFMAN MD (NPI 1659334282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659334282 NPI number — DR. BRADLEY H KOFFMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOFFMAN
Provider First Name:
BRADLEY
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659334282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6601 WINCHESTER AVE
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64133-4677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-313-2677
Provider Business Mailing Address Fax Number:
816-313-6000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5721 W 119TH ST
Provider Second Line Business Practice Location Address:
RADIATION ONCOLOGY DEPT
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66209-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-498-6270
Provider Business Practice Location Address Fax Number:
913-498-6619
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  2001018673 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 04-29308 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2087439201 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205378607 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com