Provider Demographics
NPI:1568417772
Name:THORSTAD, BRETT L (MD)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:L
Last Name:THORSTAD
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD251592085R0202X
TN251592085N0700X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3102002OtherBCBS
TN1509319OtherMEDICAID - MTI
TN1509319Medicaid
TN4201075OtherBCBS TN
TN2644117OtherCIGNA
TN300106387OtherRAILROAD MEDICARE
TN4291298OtherBCBS - MTI
KY64917941OtherKY MEDICAID
TN1600684OtherUNITED HEALTHCARE OF TN
TN3135871OtherBCBS
KY64917941Medicaid
TN3080836Medicaid
TN4076947OtherBCBS
KY64917941OtherKY MEDICAID
TN4201075OtherBCBS TN
TN3080831Medicare PIN
KY64917941Medicaid
TN4291298OtherBCBS - MTI
TN3080835Medicare PIN