Individual
DR. BRADLEY WILLIAM KOHOUTEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 4TH ST S, FARGO, ND 58103-1929
(701) 234-3100
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-9419
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
12317
ND
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17034
—
ND
Enumeration date
06/03/2009
Last updated
03/07/2024
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