MEDICARE: DR. ROBERT GRAYDON BRADLEY MD

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	174400000X	Specialist	35077683	OH
2	208600000X	Surgery Physician	35-077683	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00931021	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	311527667050	OTHER	OH	CARESOURCE
2	01417721	OTHER	OH	AMERIGROUP
3	743911	OTHER	OH	BUCKEYE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689603094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GRAYDON BRADLEY MD

Provider Business Mailing Address
First Line	:	1270 SOLUTIONS CTR
Second Line	:	P.O. BOX 771270
City	:	CHICAGO
State	:	IL
Zip	:	60677-1002
Country	:	US
Telephone Number	:	513-542-6898
Fax Number	:	513-542-7972

Provider Business Practice Location Address
First Line	:	7502 STATE ROAD
Second Line	:	SUITE 1180
City	:	CINCINNATI
State	:	OH
Zip	:	45255-2800
Country	:	US
Telephone Number	:	513-232-8181
Fax Number	:	513-624-2956

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	11/22/2011

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Directions to “ DR. ROBERT GRAYDON BRADLEY MD” Practice Location

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