Provider Demographics
NPI:1700172665
Name:KASAVANA, BRADLEY LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:LAWRENCE
Last Name:KASAVANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-7858
Mailing Address - Country:US
Mailing Address - Phone:406-862-6436
Mailing Address - Fax:406-862-6437
Practice Address - Street 1:2002 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-7858
Practice Address - Country:US
Practice Address - Phone:406-314-0010
Practice Address - Fax:406-862-9978
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT45528207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology