MEDICARE: BRADLEY J FOLKESTAD, MD, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	19824	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538329750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY J FOLKESTAD, MD, LTD

Provider Business Mailing Address
First Line	:	18699 N 67TH AVE
Second Line	:	SUITE 320
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7140
Country	:	US
Telephone Number	:	623-561-7250
Fax Number	:	623-561-0098

Provider Business Practice Location Address
First Line	:	18699 N 67TH AVE
Second Line	:	SUITE 320
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7140
Country	:	US
Telephone Number	:	623-561-7250
Fax Number	:	623-561-0098

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRADLEY J FOLKESTAD
Credential	:	MD
Telephone Number	:	623-561-7250

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	06/11/2008

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