Provider Demographics
NPI:1104988385
Name:KUSLER, BRADLEY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:DAVID
Last Name:KUSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 FAWN PARK CIR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5294
Mailing Address - Country:US
Mailing Address - Phone:402-321-4297
Mailing Address - Fax:712-328-8295
Practice Address - Street 1:105 GRANT CIR STE 133
Practice Address - Street 2:55TH AMDS-SGPS
Practice Address - City:OFFUTT A F B
Practice Address - State:NE
Practice Address - Zip Code:68113-4041
Practice Address - Country:US
Practice Address - Phone:402-294-7346
Practice Address - Fax:402-294-9138
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29399171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider