Provider Demographics
NPI:1366446122
Name:VOSSBERG, BRADLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:VOSSBERG
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 1:1517 ROCKFORD CT
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3207
Mailing Address - Country:US
Mailing Address - Phone:765-252-3370
Mailing Address - Fax:765-252-3380
Practice Address - Street 1:1517 ROCKFORD CT
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3207
Practice Address - Country:US
Practice Address - Phone:765-252-3370
Practice Address - Fax:765-252-3380
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045512A208100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300044539Medicaid
KY64037633Medicaid
KYG40218Medicare UPIN
IN152950FMedicare PIN
KY0562208Medicare PIN
ING40218Medicare UPIN
IN250012509Medicare PIN