Individual
DR. MICHELLE RENAE BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4110 51ST AVE S, FARGO, ND 58104-7776
(701) 364-3100
Mailing address
1702 SOUTH UNIVERSITY DRIVE, FARGO, ND 58103-4940
(701) 364-3100
(320) 202-0756
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14577
ND
207Q00000X
Family Medicine Physician
52168
MN
207Q00000X
Family Medicine Physician
PT14577
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036940100
—
MN
Enumeration date
07/16/2007
Last updated
07/21/2022
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