Basic Information
| Provider Information | |||||||||
| NPI: | 1073626065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANDSTED | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 823 SW MULVANE ST STE 275 | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852704355 | ||||||||
| FaxNumber: | 7852704356 | ||||||||
| Practice Location | |||||||||
| Address1: | 823 SW MULVANE ST STE 275 | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852704355 | ||||||||
| FaxNumber: | 7852704364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 04/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 04-17547 | KS | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 068002070 | 01 | KS | MEDICARE PTAN | OTHER | 100138040B | 05 | KS | MEDICAID | 340006328 | 01 | TRAVELERS MEDICARE | OTHER |