MEDICARE: DR. CRAIG BRADLEY M.D.

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
1	208200000X	Plastic Surgery Physician	036.041954	IL

General Provider Information

NPI Number	:	1598123424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG BRADLEY M.D.

Provider Business Mailing Address
First Line	:	1035 W RUNDELL PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 W RUNDELL PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2514
Country	:	US
Telephone Number	:	312-492-8445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2016
Last Update Date	:	02/06/2016

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