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1912988023

NPI Code Detail

MEDICARE: BRADLEY D RILEY MD

MEDICARE: BRADLEY D RILEY 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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	4301078635	MI
2	207PT0002X	Medical Toxicology (Emergency Medicine) Physician	4301078635	MI
3	207L00000X	Anesthesiology Physician	4301078635	MI
4	207P00000X	Emergency Medicine Physician	4301078635	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00347385	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912988023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY D RILEY MD

Provider Business Mailing Address
First Line	:	4100 EMBASSY DR SE STE 400
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2416
Country	:	US
Telephone Number	:	616-975-1845
Fax Number	:	616-285-0846

Provider Business Practice Location Address
First Line	:	100 MICHIGAN ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:	616-391-1680
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	02/20/2025

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Directions to “ BRADLEY D RILEY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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