Healthcare Provider Details

I. General information

NPI: 1700172665
Provider Name (Legal Business Name): BRADLEY LAWRENCE KASAVANA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOSPITAL WAY
WHITEFISH MT
59937-7858
US

IV. Provider business mailing address

2002 HOSPITAL WAY
WHITEFISH MT
59937-7858
US

V. Phone/Fax

Practice location:
  • Phone: 406-314-0010
  • Fax: 406-862-9978
Mailing address:
  • Phone: 406-862-6436
  • Fax: 406-862-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number45528
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: