Provider Demographics
NPI:1316914005
Name:THEDINGER, BRADLEY SEATON (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:SEATON
Last Name:THEDINGER
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 1:3100 BROADWAY SUITE 509
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2413
Mailing Address - Country:US
Mailing Address - Phone:816-531-7373
Mailing Address - Fax:816-531-1404
Practice Address - Street 1:3100 BROADWAY SUITE 509
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2413
Practice Address - Country:US
Practice Address - Phone:816-531-7373
Practice Address - Fax:816-531-1404
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7F10207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100152510CMedicaid
KSX846209Medicare PIN
KS100152510CMedicaid