Basic Information
| Provider Information | |||||||||
| NPI: | 1245305168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANDSTETTER | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2333 BUCHANAN ST | ||||||||
| Address2: | LEVEL A | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941151925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156003333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2333 BUCHANAN ST | ||||||||
| Address2: | LEVEL A | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941151925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156003333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 04/15/2010 | ||||||||
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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 | 207P00000X | 2006023031 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 01062161A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 125-048102 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 036-118616 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A102074 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 204454805 | 05 | MO | MEDICAID |