Healthcare Provider Details

I. General information

NPI: 1275960577
Provider Name (Legal Business Name): SARAH CATHERINE BRADLEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH CATHERINE COLEMAN PA

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE A721
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-3139
  • Fax: 616-391-3044
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006725
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: