Sandleback, Brad

Sandleback, Brad is an individual health care provider with primary practice located at 1818 N Meade St , Appleton WI 54911-3454. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Emergency Medical Services. Allopathic & Osteopathic Physicians / Emergency Medical Services is his primary health care specialty. Sandleback, Brad can be contacted via phone (800) 968-6866.

Contact Information

Primary practice address
1818 N Meade St Appleton WI 54911-3454
Phone: (800) 968-6866
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 42493 Wisconsin
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 42493 Wisconsin

Profile Details

NPI number 1902806698
LBN Legal business name Sandleback, Brad
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2005
Last updated Apr 20th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902806698 NPPES
Wisconsin MEDICAID 34026100

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