Healthcare Provider Details

I. General information

NPI: 1104988385
Provider Name (Legal Business Name): BRADLEY DAVID KUSLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GRANT CIR STE 133 55TH AMDS-SGPS
OFFUTT A F B NE
68113-4041
US

IV. Provider business mailing address

408 FAWN PARK CIR
COUNCIL BLUFFS IA
51503-5294
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-7346
  • Fax: 402-294-9138
Mailing address:
  • Phone: 402-321-4297
  • Fax: 712-328-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number29399
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: