Healthcare Provider Details

I. General information

NPI: 1467315176
Provider Name (Legal Business Name): BRADFORD A NICKEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 WOODLAND AVE
CLEVELAND OH
44104-2762
US

IV. Provider business mailing address

6001 WOODLAND AVE
CLEVELAND OH
44104-2762
US

V. Phone/Fax

Practice location:
  • Phone: 234-863-0360
  • Fax:
Mailing address:
  • Phone: 234-863-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: