Provider Demographics
NPI:1497954358
Name:BRADY, NATHANAEL STEVEN (DO)
Entity Type:Individual
Prefix:MR
First Name:NATHANAEL
Middle Name:STEVEN
Last Name:BRADY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:595 CHAPEL HILLS DR
Mailing Address - Street 2:102
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1024
Mailing Address - Country:US
Mailing Address - Phone:719-260-1022
Mailing Address - Fax:719-260-7790
Practice Address - Street 1:595 CHAPEL HILLS DR
Practice Address - Street 2:102
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1024
Practice Address - Country:US
Practice Address - Phone:719-260-1022
Practice Address - Fax:719-260-7790
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009046207K00000X, 208000000X
CO48591207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83737049Medicaid
COC800258Medicare UPIN