Bryan Koudim, PTA

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

License

254819 Issued in WI

Practice address

9047 W Greenfield Ave
Milwaukee, WI 53214-2808

Phone

(414) 453-9290

NPI assigned

Oct 27, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477526400000",
    "number": "1821540618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "S78W18465 LIONS PARK DR",
            "city": "MUSKEGO",
            "state": "WI",
            "postal_code": "531508704",
            "telephone_number": "262-309-1253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9047 W GREENFIELD AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532142808",
            "telephone_number": "414-453-9290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUDIM",
        "first_name": "BRYAN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-27",
        "last_updated": "2016-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "WI",
            "license": "254819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fabiana Kotovicz, MD
• Chloe Reese Kotrba
• Jessica Marie Kotsakis
• Thomas Christopher Kotsonis, M.D.
• Yuriy Kotsurovskyy, MD, MSC
• Hayden Grace Koukios, AU.D
• Dani-Joy Kovac, CNM
• Vladimir Kovacevic, M.D.
• Jenny Dente Kovach, MD
• Joshua Kovach, MD

• Other Specialist/Technologist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Other Specialist/Technologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.