Individual
ALLEN C BRAGDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
(616) 391-5330
Mailing address
100 MICHIGAN ST NE, MC 71, GRAND RAPIDS, MI 49503-2560
(616) 391-5330
(616) 391-5343
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4301072324
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301072324
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285659177
—
MI
01
—
930106271
RAILROAD MEDICARE
MI
01
—
P00397048
RAILROAD MEDICARE
MI
Enumeration date
07/13/2006
Last updated
05/14/2013
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