Provider Demographics
NPI:1740256593
Name:BRADY, IGNATIUS J (MD)
Entity type:Individual
Prefix:
First Name:IGNATIUS
Middle Name:J
Last Name:BRADY
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 1:830 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5004
Mailing Address - Country:US
Mailing Address - Phone:319-369-7173
Mailing Address - Fax:319-368-5521
Practice Address - Street 1:830 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-369-7173
Practice Address - Fax:319-368-5521
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-33662204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAMD-33662OtherSTATE MEDICAL LICENSE
IA1221218Medicaid
H35255Medicare UPIN