Individual
BRADI MICHAEL PETER KIPPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2300 53RD AVE, SUITE 100, BETTENDORF, IA 52722-7564
(563) 322-0971
(563) 324-0615
Mailing address
2300 53RD AVE, SUITE 100, BETTENDORF, IA 52722-7564
(563) 322-0971
(563) 324-0615
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002217
IA
363A00000X
Physician Assistant
085004237
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
578210014
MEDICARE PTAN
IA
Enumeration date
08/17/2011
Last updated
11/14/2011
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