Provider Demographics
NPI:1528038569
Name:KIRSCHNER, BRADLEY W (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:KIRSCHNER
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 1:316 MARTIN L KING JR WAY STE 212
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4254
Mailing Address - Country:US
Mailing Address - Phone:253-383-5777
Mailing Address - Fax:253-627-0855
Practice Address - Street 1:1628 S MILDRED ST STE 101
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1628
Practice Address - Country:US
Practice Address - Phone:253-383-5777
Practice Address - Fax:253-627-0855
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60659908208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH19063Medicare UPIN
WI68735Medicare ID - Type Unspecified