Healthcare Provider Details

I. General information

NPI: 1174623540
Provider Name (Legal Business Name): BRADLEY J CONDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NE SAINT LUKES BLVD
LEES SUMMIT MO
64086-1000
US

IV. Provider business mailing address

901 E 104TH ST # MS 400S
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-3679
  • Fax:
Mailing address:
  • Phone: 816-932-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number04-29441
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2003009757
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number04-29441
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: