Healthcare Provider Details

I. General information

NPI: 1982205308
Provider Name (Legal Business Name): BRAD STORM MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23351 PRAIRIE STAR PKWY STE 275
LENEXA KS
66227-6201
US

IV. Provider business mailing address

7500 COLLEGE BLVD STE 500
OVERLAND PARK KS
66210-4043
US

V. Phone/Fax

Practice location:
  • Phone: 913-815-4701
  • Fax: 913-815-4703
Mailing address:
  • Phone: 913-815-4705
  • Fax: 913-915-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHI S SMITH
Title or Position: PRACTICE MANAGER
Credential:
Phone: 913-815-4705