Healthcare Provider Details

I. General information

NPI: 1558898239
Provider Name (Legal Business Name): BRADLEY LEPORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22101 MOROSS RD
DETROIT MI
48236-2148
US

IV. Provider business mailing address

22101 MOROSS RD
DETROIT MI
48236-2148
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-3400
  • Fax:
Mailing address:
  • Phone: 313-343-3400
  • Fax: 313-343-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4351028313
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301112028
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301501681
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01091090A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: