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General NPI Number Information
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NPI Number | 1922119130
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Entity Type | Organization
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Legal Business Name | BRADLEY AHLGREN MD PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 1555 SOUTH BLVD E
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5605
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Country | US
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Telephone | 248-215-8080
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Fax | 248-289-1086
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Provider Business Mailing Address
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Address Line | 1555 SOUTH BLVD E
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5605
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Country | US
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Telephone | 248-215-8080
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Fax | 248-289-1086
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRADLEY D AHLGREN
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Credential | MD
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Telephone | 248-215-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | BA054228
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License Number State | MI
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