=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942499355
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADLEY DUNKIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2007
-----------------------------------------------------
Last Update Date | 08/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6641 DIXIE HWY
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40258-3909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-364-0902
-----------------------------------------------------
Fax | 502-364-0099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 560 S LOOP RD
-----------------------------------------------------
City | EDGEWOOD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41017-3405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-301-2663
-----------------------------------------------------
Fax | 859-301-2663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 57013901
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 45243
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 45243
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------