MEDICARE: BRADLEY RICHARD HAKIM DO

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	DR.0065363	CO

General Provider Information

NPI Number	:	1205229945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY RICHARD HAKIM DO

Provider Business Mailing Address
First Line	:	8500 PARK MEADOWS DR STE 200
Second Line	:
City	:	LONE TREE
State	:	CO
Zip	:	80124-2744
Country	:	US
Telephone Number	:	586-322-4824
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 PARK MEADOWS DR STE 200
Second Line	:
City	:	LONE TREE
State	:	CO
Zip	:	80124-2744
Country	:	US
Telephone Number	:	586-322-4824
Fax Number	:

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

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	11/12/2020

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