Individual
BRAD SANDLEBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1818 N MEADE ST, APPLETON, WI 54911-3454
(800) 968-6866
Mailing address
PO BOX 88215, MILWAUKEE, WI 53288-0001
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
42493
WI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
42493
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34026100
—
WI
Enumeration date
07/26/2005
Last updated
04/20/2008
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