Provider Demographics
NPI:1245305168
Name:BRANDSTETTER, KEVIN DAVID (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DAVID
Last Name:BRANDSTETTER
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 1:2333 BUCHANAN ST
Mailing Address - Street 2:LEVEL A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1925
Mailing Address - Country:US
Mailing Address - Phone:415-600-3333
Mailing Address - Fax:
Practice Address - Street 1:2333 BUCHANAN ST
Practice Address - Street 2:LEVEL A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1925
Practice Address - Country:US
Practice Address - Phone:415-600-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006023031207P00000X
IN01062161A207P00000X
IL125-048102207P00000X
IL036-118616207P00000X
CAA102074207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204454805Medicaid
I69754Medicare UPIN
MO964104748Medicare PIN
MO964104740Medicare PIN