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General NPI Number Information
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NPI Number | 1679779011
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Entity Type | Organization
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Legal Business Name | BRADFORD MERRELLI MD PC
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 595 BARCLAY CIR SUITE D
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5802
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Country | US
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Telephone | 248-852-5355
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Fax | 248-852-8411
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Provider Business Mailing Address
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Address Line | 595 BARCLAY CIR SUITE D
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5802
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Country | US
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Telephone | 248-852-5355
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Fax | 248-852-8411
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADFORD J MERRELLI
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Credential | M.D.
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Telephone | 248-852-5355
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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 | 4301048826
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License Number State | MI
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