Provider Demographics
NPI:1093887184
Name:BRATKIEWICZ, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:BRATKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2997
Mailing Address - Country:US
Mailing Address - Phone:515-225-6548
Mailing Address - Fax:
Practice Address - Street 1:4713 BROOKVIEW DR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2997
Practice Address - Country:US
Practice Address - Phone:515-225-6548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22221207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA110095637OtherRAILROAD MEDICARE
IA2209932Medicaid
IA1209932Medicaid
IA54713Medicare ID - Type UnspecifiedIMMC MEDICARE
IA1209932Medicaid
IA54699Medicare ID - Type UnspecifiedILH MEDICARE