Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301072906 | MI |
Y | 2080P0202X | Pediatric Cardiologist | 4301072906 | MI |
N | 2080P0202X | Pediatric Cardiologist | 4961827-1205 | UT |
NPI | 1184703654 |
---|---|
Provider Name | David James Bradley |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 01/10/2019 |