Healthcare Provider Details

I. General information

NPI: 1356718837
Provider Name (Legal Business Name): BRADLEY SEBOE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7103 SAN PEDRO AVE STE A
SAN ANTONIO TX
78216-6219
US

IV. Provider business mailing address

750 N COMMONS DR STE 200
AURORA IL
60504-7940
US

V. Phone/Fax

Practice location:
  • Phone: 210-348-5556
  • Fax: 210-348-5449
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1477-60
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80939
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: