Provider Demographics
NPI:1538151287
Name:KAMSTRA, BRADLEY DEAN (DO)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DEAN
Last Name:KAMSTRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HEGG DR
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1445
Mailing Address - Country:US
Mailing Address - Phone:712-476-8100
Mailing Address - Fax:712-476-8190
Practice Address - Street 1:2121 HEGG DR
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1445
Practice Address - Country:US
Practice Address - Phone:712-476-8100
Practice Address - Fax:712-476-8190
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1163311Medicaid
IA1163311Medicaid
G31532Medicare UPIN