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General NPI Number Information
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NPI Number | 1518968460
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Entity Type | Individual
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Provider Name | TODD M. BRADSHAW MD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 225 MEMORIAL DR STE 1200
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City | BERLIN
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State | WI
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Zip | 54923-1243
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Country | US
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Telephone | 920-361-5770
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Fax | 920-361-5779
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Provider Business Mailing Address
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Address Line | 225 MEMORIAL DR STE 1200
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City | BERLIN
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State | WI
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Zip | 54923-1243
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Country | US
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Telephone | 920-361-5770
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Fax | 920-361-5779
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36541-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 36541-020
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License Number State | WI
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