Provider Demographics
NPI:1952755951
Name:BUDDE, BRADLEY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JOSEPH
Last Name:BUDDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:618-212-6620
Mailing Address - Fax:618-212-6621
Practice Address - Street 1:4700 MEMORIAL DR
Practice Address - Street 2:DIV WUPI NEUROSURGERY, STE 230
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5373
Practice Address - Country:US
Practice Address - Phone:618-212-6620
Practice Address - Fax:618-212-6621
Is Sole Proprietor?:No
Enumeration Date:2016-04-16
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036170326207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200128175Medicaid