Provider Demographics
NPI:1053537167
Name:KAST, BRADLEY ADAM (DO)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ADAM
Last Name:KAST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7799 NEW HOLLAND WAY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6343
Mailing Address - Country:US
Mailing Address - Phone:561-737-1199
Mailing Address - Fax:
Practice Address - Street 1:1155 35TH LN
Practice Address - Street 2:SUITE 201
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6521
Practice Address - Country:US
Practice Address - Phone:772-794-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315027562207R00000X
FLOS 10652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine