Healthcare Provider Details

I. General information

NPI: 1841389822
Provider Name (Legal Business Name): BRADLEY S EILERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7388 TURFWAY RD
FLORENCE KY
41042-1381
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-8910
  • Fax: 859-655-8914
Mailing address:
  • Phone: 859-655-8910
  • Fax: 859-655-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number39906
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number39906
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.084080
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39906
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: