Healthcare Provider Details

I. General information

NPI: 1710107701
Provider Name (Legal Business Name): JOYCE DENISE BRADFORD DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: J D BRADFORD DPM

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 TOWN CTR STE 1900
SOUTHFIELD MI
48075-1152
US

IV. Provider business mailing address

2000 TOWN CTR STE 1900
SOUTHFIELD MI
48075-1152
US

V. Phone/Fax

Practice location:
  • Phone: 248-565-4024
  • Fax: 775-587-3115
Mailing address:
  • Phone: 248-565-4024
  • Fax: 775-587-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number001148
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number001148
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number001148
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: