Provider Demographics
NPI:1689640229
Name:BRADLEY, JAMES KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEITH
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 451
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7218
Mailing Address - Country:US
Mailing Address - Phone:913-829-0446
Mailing Address - Fax:913-829-7829
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 451
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7218
Practice Address - Country:US
Practice Address - Phone:913-829-0446
Practice Address - Fax:913-829-7829
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-18815207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100198850AMedicaid
KS100198850AMedicaid
KSC51712Medicare UPIN