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Individual
MICHELLE RAE BRADDY
Active
Individual
MICHELLE RAE BRADDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036120332
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036120332
ILLINOIS PHYSICIAN LICENSE
IL
05
—
036120332
—
IL
01
—
14D0921285
CLIA ID NUMBER
IL
01
—
151351
HEALTH ALLIANCE
IL
01
—
2523247
BLUE CROSS BLUE SHIELD
IL
01
—
336082411
ILLINOIS CONTROLLED SUBSTANCE LICENSE
IL
01
—
371391171005
MEDICAID RURAL HEALTH
IL
05
—
371391171005
—
IL
01
—
561920
MEDICARE GROUP PTAN
IL
01
—
930280
HEALTHLINK
IL
01
—
P00790343
RAILROAD MEDICARE
IL
Enumeration date
09/28/2006
Last updated
03/07/2023
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