Provider Demographics
NPI:1710953518
Name:RUPP, BRADLEY W (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:RUPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:631 SW HORNE ST
Mailing Address - Street 2:STE 150
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1694
Mailing Address - Country:US
Mailing Address - Phone:785-354-7877
Mailing Address - Fax:785-354-7878
Practice Address - Street 1:631 SW HORNE ST
Practice Address - Street 2:STE 150
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1694
Practice Address - Country:US
Practice Address - Phone:785-354-7877
Practice Address - Fax:785-354-7878
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0429141208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100391050CMedicaid
H34635Medicare UPIN
KS100391050CMedicaid