Individual
BRADLEY BLISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
14477 CABERFAE HWY, WELLSTON, MI 49689-9315
(231) 848-4777
Mailing address
14477 CABERFAE HWY, WELLSTON, MI 49689-9315
(231) 848-4777
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601007455
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601001299
MICHIGAN PAC LICENSE
MI
Enumeration date
10/09/2006
Last updated
03/07/2023
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