=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205229945
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADLEY RICHARD HAKIM DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2015
-----------------------------------------------------
Last Update Date | 11/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8500 PARK MEADOWS DR STE 200
-----------------------------------------------------
City | LONE TREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-322-4824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8500 PARK MEADOWS DR STE 200
-----------------------------------------------------
City | LONE TREE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80124-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-322-4824
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | DR.0065363
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------