Healthcare Provider Details

I. General information

NPI: 1497911697
Provider Name (Legal Business Name): JANE BRADLAW D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ROOSEVELT RD DEPARTMENT OF EMERGENCY MEDICINE
VALPARAISO IN
46383-2800
US

IV. Provider business mailing address

PO BOX 6755
SAN DIEGO CA
92166-0755
US

V. Phone/Fax

Practice location:
  • Phone: 219-477-5242
  • Fax: 219-477-4859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A18845
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02003905B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: