Healthcare Provider Details

I. General information

NPI: 1790731693
Provider Name (Legal Business Name): DAVID M BRADLEE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43902 WOODWARD AVE SUITE 240
BLOOMFIELD HILLS MI
48302-5011
US

IV. Provider business mailing address

43902 WOODWARD AVE SUITE 240
BLOOMFIELD HILLS MI
48302-5011
US

V. Phone/Fax

Practice location:
  • Phone: 248-454-7650
  • Fax: 248-454-9794
Mailing address:
  • Phone: 248-454-7650
  • Fax: 248-454-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number5101011456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: