Individual
MICHAEL G FRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 TAMPA GENERAL CIR, STC 5TH FLOOR, TAMPA, FL 33606-3603
(813) 259-0660
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
235029
MA
207RC0000X
Cardiovascular Disease Physician
Primary
ME116200
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009166800
—
FL
01
—
14QW3
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/29/2007
Last updated
11/06/2014
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