Provider Demographics
NPI:1659477735
Name:BEVACQUA, BRIAN KRISS (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KRISS
Last Name:BEVACQUA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:MADISON VAMC 2500 OVERLOOK TERRACE
Mailing Address - Street 2:112A
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705
Mailing Address - Country:US
Mailing Address - Phone:608-256-1901
Mailing Address - Fax:608-280-7098
Practice Address - Street 1:2500 OVERLOOK TER
Practice Address - Street 2:112A
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2254
Practice Address - Country:US
Practice Address - Phone:608-256-1901
Practice Address - Fax:608-280-7098
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI23925207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology