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General NPI Number Information
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NPI Number | 1154357085
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Entity Type | Individual
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Provider Name | BRADLEY J CHAMPAGNE MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 11100 EUDLID AVENUE
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City | CLEVELAND
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State | OH
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Zip | 44106
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Country | US
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Telephone | 216-844-7874
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Fax |
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Provider Business Mailing Address
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Address Line | 3605 WARRENSVILLE CENTER RD 1ST FLOOR
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122
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Country | US
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Telephone | 216-286-6295
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Fax | 216-286-6341
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 056041
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License Number State | GA
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