Provider Demographics
NPI:1952380255
Name:OLDS, BRADLEY S (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:S
Last Name:OLDS
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 1:2120 CONTEMPORARY LN
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-6769
Mailing Address - Country:US
Mailing Address - Phone:502-376-5886
Mailing Address - Fax:
Practice Address - Street 1:800 ZORN AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:502-287-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38168207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64047046Medicaid
KY50006762OtherPASSPORT ID#
KY000000057464OtherANTHEM ID#
KY64047046Medicaid
KY0048644Medicare ID - Type UnspecifiedMEDICARE PROV ID#