Healthcare Provider Details

I. General information

NPI: 1487213542
Provider Name (Legal Business Name): BRANDON J STRADEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 LIME KILN RD STE 1
GREEN BAY WI
54311-6238
US

IV. Provider business mailing address

2223 LIME KILN RD STE 1
GREEN BAY WI
54311-6238
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-8113
  • Fax:
Mailing address:
  • Phone: 920-430-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351045456
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number76143
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number76332
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: