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NPI Code Detail

MEDICARE: BRAD A BLAKER DO

MEDICARE: BRAD A BLAKER DO
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
1207P00000XEmergency Medicine Physician83418SC
2207P00000XEmergency Medicine Physician34.016136OH
3207P00000XEmergency Medicine Physician02006247AIN
4207PE0004XEmergency Medical Services (Emergency Medicine) Physician5101013885MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790769545
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAD A BLAKER DO
Provider Business Mailing Address
First Line : 50 N PERRY ST
Second Line :
City : PONTIAC
State : MI
Zip : 48342-2217
Country : US
Telephone Number : 248-338-5327
Fax Number : 248-338-5129
Provider Business Practice Location Address
First Line : 50 N PERRY ST
Second Line :
City : PONTIAC
State : MI
Zip : 48342-2217
Country : US
Telephone Number : 248-338-5327
Fax Number : 248-338-5129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 12/08/2025

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Directions to “ BRAD A BLAKER DO” Practice Location

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