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General NPI Number Information
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NPI Number | 1205974052
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Entity Type | Individual
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Provider Name | BRADLEY NEAL FRIEDLAND D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 2428 LAKE DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-3162
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Country | US
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Telephone | 616-957-1217
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Fax |
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Provider Business Mailing Address
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Address Line | 2428 LAKE DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-3162
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Country | US
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Telephone | 616-957-1217
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Fax |
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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 | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 5101007429
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License Number State | MI
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