Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036.138040 | IL |
N | 208000000X | Pediatrician | 4301100476 | MI |
Y | 2080P0203X | Pediatric Critical Care Doctor | 036.138040 | IL |
NPI | 1093076747 |
---|---|
Provider Name | Erin Bradley |
First Address | Chicago, IL 60611-2991 |
Second Address | Chicago, IL 60611-2991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 23/03/2018 |