MEDICARE: MICAH BRADFORD

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	342000000X	Transportation Network Company

General Provider Information

NPI Number	:	1518739598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAH BRADFORD

Provider Business Mailing Address
First Line	:	2783 SALEM HILLS CT
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-9517
Country	:	US
Telephone Number	:	614-432-3340
Fax Number	:

Provider Business Practice Location Address
First Line	:	2783 SALEM HILLS CT
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-9517
Country	:	US
Telephone Number	:	614-432-3340
Fax Number	:

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

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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Directions to “ MICAH BRADFORD ” Practice Location

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