Provider Demographics
NPI:1356323554
Name:THORGAARD, BRADLEY ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALLAN
Last Name:THORGAARD
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 1:3300 KINGMAN RD
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-3943
Mailing Address - Country:US
Mailing Address - Phone:515-292-8819
Mailing Address - Fax:
Practice Address - Street 1:3300 KINGMAN RD
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-3943
Practice Address - Country:US
Practice Address - Phone:515-292-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23720208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0050344Medicaid
IAA03639Medicare UPIN
IA0050344Medicaid