Provider Demographics
NPI:1912109760
Name:BRENDE, JOEL O (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:O
Last Name:BRENDE
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 1:5325 FARAON ST.
Mailing Address - Street 2:
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3488
Mailing Address - Country:US
Mailing Address - Phone:816-271-7273
Mailing Address - Fax:816-271-7376
Practice Address - Street 1:5325 FARAON ST.
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3488
Practice Address - Country:US
Practice Address - Phone:816-271-7273
Practice Address - Fax:816-271-7376
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ290022084P0800X
AZ2990022084P0800X
MO20070088462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ053184Medicaid
D39475Medicare UPIN
AZ053184Medicaid
AZD39475Medicare UPIN