MEDICARE: MR. BRADLEY JAMES QUALEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	32730	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154319127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADLEY JAMES QUALEY MD

Provider Business Mailing Address
First Line	:	523 N 3RD ST
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-3054
Country	:	US
Telephone Number	:	218-829-2861
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 S 6TH ST
Second Line	:	STE 3
City	:	BRAINERD
State	:	MN
Zip	:	56401-4529
Country	:	US
Telephone Number	:	218-828-7100
Fax Number	:	218-833-8037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	01/08/2016

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