Healthcare Provider Details

I. General information

NPI: 1457064669
Provider Name (Legal Business Name): BRADLEY CHARLES HERZBERG FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S SAGINAW ST
FLINT MI
48507-2677
US

IV. Provider business mailing address

2101 E COURT ST
FLINT MI
48503-6416
US

V. Phone/Fax

Practice location:
  • Phone: 810-275-9333
  • Fax:
Mailing address:
  • Phone: 989-395-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704286267
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: