Individual
STEPHEN JEROME BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4160 JOHN R ST, STE 615, DETROIT, MI 48201-2020
(313) 745-4195
(313) 745-8669
Mailing address
1560 E MAPLE RD, SUITE 400 - CREDENTIALING DEPARTMENT, TROY, MI 48083-1138
(313) 745-4195
(313) 993-8669
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301050040
MI
2086S0102X
Surgical Critical Care Physician
Primary
4301050040
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020017324
RAILROAD MEDICARE
—
05
—
036078462
—
IL
05
—
31523400
—
WI
Enumeration date
07/07/2006
Last updated
10/17/2016
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