Healthcare Provider Details

I. General information

NPI: 1821772534
Provider Name (Legal Business Name): BRADLEY POZIEMBO CPLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CHESTER BLVD
RICHMOND IN
47374-1214
US

IV. Provider business mailing address

2011 CHESTER BLVD
RICHMOND IN
47374-1214
US

V. Phone/Fax

Practice location:
  • Phone: 765-756-5014
  • Fax: 765-488-1165
Mailing address:
  • Phone: 765-756-5014
  • Fax: 765-488-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number258
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: