MEDICARE: MICHAEL B. BRADSHAW 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	207N00000X	Dermatology Physician	A118993	CA

General Provider Information

NPI Number	:	1861646267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL B. BRADSHAW M.D.

Provider Business Mailing Address
First Line	:	9878 HIBERT ST
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1020
Country	:	US
Telephone Number	:	858-693-3000
Fax Number	:	858-693-3700

Provider Business Practice Location Address
First Line	:	9878 HIBERT ST
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1020
Country	:	US
Telephone Number	:	858-693-3000
Fax Number	:	858-693-3700

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

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	10/26/2016

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