Healthcare Provider Details

I. General information

NPI: 1114031580
Provider Name (Legal Business Name): BRIDGET BRANSTEITTER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-8445
  • Fax:
Mailing address:
  • Phone: 816-781-8445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2004024399
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: