Provider Demographics
NPI:1114031580
Name:BRANSTEITTER, BRIDGET (DO)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:BRANSTEITTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19201 E VALLEY VIEW PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6910
Mailing Address - Country:US
Mailing Address - Phone:816-254-2552
Mailing Address - Fax:816-833-4155
Practice Address - Street 1:19201 E VALLEY VIEW PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6910
Practice Address - Country:US
Practice Address - Phone:816-254-2552
Practice Address - Fax:816-833-4155
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024399207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1114031580Medicaid
KS200576970 AMedicaid
MOT56000002Medicare PIN
MORES000BRBMedicare UPIN
MOP00655727Medicare PIN