Healthcare Provider Details

I. General information

NPI: 1932187598
Provider Name (Legal Business Name): BRADLEY R CALOIA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD EMERGENCY MEDICINE DPARTMENT
DEARBORN MI
48124-4089
US

IV. Provider business mailing address

38935 ANN ARBOR RD
LIVONIA MI
48150-3354
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-8780
  • Fax: 313-436-2864
Mailing address:
  • Phone: 734-632-0175
  • Fax: 734-632-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101015016
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102202294
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: