Healthcare Provider Details

I. General information

NPI: 1942267778
Provider Name (Legal Business Name): BRADLEY J GARRETT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
EATON RAPIDS MI
48827-1952
US

IV. Provider business mailing address

1031 E SAGINAW ST
LANSING MI
48906-5519
US

V. Phone/Fax

Practice location:
  • Phone: 517-663-9555
  • Fax:
Mailing address:
  • Phone: 517-487-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO25658
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101015114
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: