Healthcare Provider Details

I. General information

NPI: 1871170407
Provider Name (Legal Business Name): BRYAN DAVID VANDREESE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 KNUTSON DR
MADISON WI
53704-1133
US

IV. Provider business mailing address

317 KNUTSON DR
MADISON WI
53704-1133
US

V. Phone/Fax

Practice location:
  • Phone: 608-301-1996
  • Fax: 608-223-7727
Mailing address:
  • Phone: 608-301-1996
  • Fax: 608-223-7727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number72063
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31668
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number81048-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: