Healthcare Provider Details

I. General information

NPI: 1699466995
Provider Name (Legal Business Name): BRAD CAMDEN ZWART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E HOLLY BLVD
BRANDON SD
57005-1426
US

IV. Provider business mailing address

1101 E HOLLY BLVD
BRANDON SD
57005-1426
US

V. Phone/Fax

Practice location:
  • Phone: 605-582-3853
  • Fax:
Mailing address:
  • Phone: 605-582-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18766
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: