Healthcare Provider Details

I. General information

NPI: 1730573650
Provider Name (Legal Business Name): BRADLEY DAVIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-6450
  • Fax: 414-805-6464
Mailing address:
  • Phone: 414-805-6450
  • Fax: 414-805-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036146349
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: