Provider Demographics
NPI:1932632072
Name:WHILES, BRISTOL BRANDT (MD)
Entity Type:Individual
Prefix:
First Name:BRISTOL
Middle Name:BRANDT
Last Name:WHILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRISTOL
Other - Middle Name:NICOLE
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12119 W 164TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-7733
Mailing Address - Country:US
Mailing Address - Phone:816-769-3266
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-2640
Practice Address - Country:US
Practice Address - Phone:913-945-8239
Practice Address - Fax:913-588-7625
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155054208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology