Healthcare Provider Details

I. General information

NPI: 1528074416
Provider Name (Legal Business Name): BRADLEY FRANK GUTIERREZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD DEPT OF
WARREN MI
48093-3472
US

IV. Provider business mailing address

17400 BEECHWOOD AVE
BEVERLY HILLS MI
48025
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5059
  • Fax:
Mailing address:
  • Phone: 248-540-5848
  • Fax: 248-540-5848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101015154
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: