MEDICARE: BRADFORD J BANDEMER

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	101YP2500X	Professional Counselor	6401002118	MI

General Provider Information

NPI Number	:	1629244033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADFORD J BANDEMER

Provider Business Mailing Address
First Line	:	209 E WASHINGTON AVE
Second Line	:	SUITE 220
City	:	JACKSON
State	:	MI
Zip	:	49201-2393
Country	:	US
Telephone Number	:	517-782-0100
Fax Number	:	517-782-1195

Provider Business Practice Location Address
First Line	:	209 E WASHINGTON AVE
Second Line	:	SUITE 220
City	:	JACKSON
State	:	MI
Zip	:	49201-2393
Country	:	US
Telephone Number	:	517-782-0100
Fax Number	:	517-782-1195

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

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	05/06/2008

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Directions to “ BRADFORD J BANDEMER ” Practice Location

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