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NPI Code Detail

MEDICARE: BRADFORD A NICKEL

MEDICARE: BRADFORD A NICKEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistOH

General Provider Information

NPI Number : 1467315176
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADFORD A NICKEL
Provider Business Mailing Address
First Line : 6001 WOODLAND AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44104-2762
Country : US
Telephone Number : 234-863-0360
Fax Number :
Provider Business Practice Location Address
First Line : 6001 WOODLAND AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44104-2762
Country : US
Telephone Number : 234-863-0360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2025
Last Update Date : 12/09/2025

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Directions to “ BRADFORD A NICKEL ” Practice Location

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