MEDICARE: BRADLEY WILLIAM WISE

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	208600000X	Surgery Physician	DR.0063626	CO

General Provider Information

NPI Number	:	1679060818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY WILLIAM WISE

Provider Business Mailing Address
First Line	:	4545 E 9TH AVE STE 120
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-3902
Country	:	US
Telephone Number	:	303-388-2922
Fax Number	:	303-388-2962

Provider Business Practice Location Address
First Line	:	4545 E 9TH AVE STE 120
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-3902
Country	:	US
Telephone Number	:	303-388-2922
Fax Number	:	303-388-2962

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

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	09/13/2023

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Directions to “ BRADLEY WILLIAM WISE ” Practice Location

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