# DR. MARK W BRANDSTED

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1073626065
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 04-17547 | KS | Yes |

## Other

- **Enumeration date:** 08/16/2006
- **Last updated:** 04/06/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 068002070 | MEDICARE PTAN | KS |
| 05 | — | 100138040B | — | KS |
| 01 | — | 340006328 | TRAVELERS MEDICARE | — |