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NPI Code Detail

MEDICARE: BRADD G HEMKER M.D.

MEDICARE: BRADD G HEMKER M.D.
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
1207R00000XInternal Medicine Physician5153720WI
2208000000XPediatrics Physician5153720WI
32080H0002XPediatric Hospice and Palliative Medicine Physician5153720WI
42080P0207XPediatric Hematology & Oncology Physician4301101630MI
5208000000XPediatrics Physician4301101630MI

Other Identifiers

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

General Provider Information

NPI Number : 1366632408
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADD G HEMKER M.D.
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 MICHIGAN ST NE
Second Line : 10TH FLOOR
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number : 616-267-1925
Fax Number : 616-267-1005
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2007
Last Update Date : 03/18/2021

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Directions to “ BRADD G HEMKER M.D.” Practice Location

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