Individual
BRADLEY D BASTOW
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
950 BLUE STAR HWY, SUITE 1-2, SOUTH HAVEN, MI 49090-7759
(269) 637-1388
(269) 637-1459
Mailing address
950 BLUE STAR HWY, SUITE 1-2, SOUTH HAVEN, MI 49090-7759
(269) 637-1388
(269) 637-1459
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
5101008849
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3449722
—
MI
Enumeration date
11/09/2005
Last updated
07/08/2007
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