Provider Demographics
NPI:1497763445
Name:BRONANDER, KIRK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:ALAN
Last Name:BRONANDER
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 1:1155 MILL STREET
Mailing Address - Street 2:W11
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-327-5174
Mailing Address - Fax:775-327-5178
Practice Address - Street 1:1155 MILL STREET
Practice Address - Street 2:W11
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-327-5174
Practice Address - Fax:775-327-5178
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV35011Medicare PIN
NVH39035Medicare UPIN