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General NPI Number Information
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NPI Number | 1558372383
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Entity Type | Individual
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Provider Name | BRADFORD GREGORY BICHEY MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 330 N WABASH AVE SUITE 210
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City | MARION
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State | IN
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Zip | 46952-2600
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Country | US
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Telephone | 317-770-0055
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Fax | 317-770-0066
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Provider Business Mailing Address
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Address Line | PO BOX 1385
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-1385
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Country | US
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Telephone | 317-770-0055
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Fax | 317-770-0066
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 01057899A
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License Number State | IN
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