Individual
BRADLEY J CHAMPAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUDLID AVENUE, CLEVELAND, OH 44106
(216) 844-7874
Mailing address
3605 WARRENSVILLE CENTER RD, 1ST FLOOR, SHAKER HEIGHTS, OH 44122
(216) 286-6295
(216) 286-6341
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
056041
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221043
UNISON
OH
01
—
000000503701
ANTHEM
OH
01
—
056041
MEDICAL LICENSE
GA
05
—
10025555600
—
NE
05
—
2681021
—
OH
01
—
363406
WELLCARE
OH
01
—
7396822
AETNA
OH
01
—
745528
BUDKEYE
OH
01
—
P00385103
RAILROAD MEDICARE
OH
Enumeration date
06/23/2006
Last updated
01/13/2010
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