Healthcare Provider Details

I. General information

NPI: 1215357033
Provider Name (Legal Business Name): BRADLEY ANTHONY KING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2014
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MERCY HEALTH BLVD STE 450
CINCINNATI OH
45211-1106
US

IV. Provider business mailing address

3301 MERCY HEALTH BLVD STE 450
CINCINNATI OH
45211-1106
US

V. Phone/Fax

Practice location:
  • Phone: 513-981-6784
  • Fax: 513-215-9397
Mailing address:
  • Phone: 513-981-6784
  • Fax: 513-215-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number52599
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.025028
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number57.025028
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number52599
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: