Provider Demographics
NPI:1982205308
Name:BRAD STORM MD LLC
Entity Type:Organization
Organization Name:BRAD STORM MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHI
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-815-4705
Mailing Address - Street 1:7500 COLLEGE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-4043
Mailing Address - Country:US
Mailing Address - Phone:913-815-4705
Mailing Address - Fax:913-915-4703
Practice Address - Street 1:23351 PRAIRIE STAR PKWY STE 275
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-6201
Practice Address - Country:US
Practice Address - Phone:913-815-4701
Practice Address - Fax:913-815-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100120050CMedicaid