MEDICARE: AUDREY ELISE 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	363A00000X	Physician Assistant	5601013822	MI

General Provider Information

NPI Number	:	1578415089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY ELISE BRADFORD

Provider Business Mailing Address
First Line	:	410 N WILLOWBROOK RD
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-9576
Country	:	US
Telephone Number	:	517-279-9599
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 N WILLOWBROOK RD
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-9576
Country	:	US
Telephone Number	:	517-279-9599
Fax Number	:

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

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “ AUDREY ELISE BRADFORD ” Practice Location

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