Healthcare Provider Details

I. General information

NPI: 1205844131
Provider Name (Legal Business Name): BRADFORD LEE BOPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12188 A NORTH MERIDIAN STREET SUITE 250
CARMEL IN
46032
US

IV. Provider business mailing address

PO BOX 772437
DETROIT MI
48277-2437
US

V. Phone/Fax

Practice location:
  • Phone: 317-571-1637
  • Fax: 317-571-9483
Mailing address:
  • Phone: 317-575-7304
  • Fax: 317-575-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number01047051A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: