Individual
BRADLEY JAY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(586) 573-5060
Mailing address
11800 EAST 12 MILE ROAD, WARREN, MI 48093
(586) 573-5060
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
4301098675
MI
2085R0202X
Diagnostic Radiology Physician
4301097675
MI
2085R0202X
Diagnostic Radiology Physician
Primary
4301098675
MI
Other
Enumeration date
07/01/2011
Last updated
03/17/2018
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