Healthcare Provider Details

I. General information

NPI: 1316914005
Provider Name (Legal Business Name): BRADLEY SEATON THEDINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 BROADWAY SUITE 509
KANSAS CITY MO
64111-2413
US

IV. Provider business mailing address

3100 BROADWAY SUITE 509
KANSAS CITY MO
64111-2413
US

V. Phone/Fax

Practice location:
  • Phone: 816-531-7373
  • Fax: 816-531-1404
Mailing address:
  • Phone: 816-531-7373
  • Fax: 816-531-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberR7F10
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: