Provider Demographics
NPI:1558325282
Name:MCILNAY, BRADLEY JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JOSEPH
Last Name:MCILNAY
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 1:5800 FOXRIDGE DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2333
Mailing Address - Country:US
Mailing Address - Phone:913-261-3153
Mailing Address - Fax:913-262-3295
Practice Address - Street 1:11011 HASKELL AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-8500
Practice Address - Country:US
Practice Address - Phone:913-667-5667
Practice Address - Fax:913-791-4219
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL33942085R0202X
KS04-319212085R0202X
MO20060131652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200386020BMedicaid
MO201004009Medicaid
KS200386020AMedicaid
MO201004009Medicaid
KS200386020BMedicaid
KSJ96E578AMedicare PIN
KS105695Medicare PIN