Provider Demographics
NPI:1548208176
Name:BRUNER, BRADLEY W (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:BRUNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10100 E SHANNON WOODS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4104
Mailing Address - Country:US
Mailing Address - Phone:316-219-8299
Mailing Address - Fax:316-219-5899
Practice Address - Street 1:10100 E SHANNON WOODS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4104
Practice Address - Country:US
Practice Address - Phone:316-219-8299
Practice Address - Fax:316-219-5899
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2017-04-05
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Provider Licenses
StateLicense IDTaxonomies
KS0423086207X00000X
KS04-23086207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS624020OtherFIRST GUARD
200045358OtherRR MEDICARE
KS102519OtherBLUE SHIELD
KS100124260DMedicaid
KS1672OtherPREFERRED HEALTH SYSTEMS
E70361Medicare UPIN
E70361Medicare UPIN