Organization
ANN MARIE BRADLEY ENTERPRISES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY TAGLIONE BILLING CEO (BILLING CEO)
(734) 414-0754
Entity
Organization
Contact information
Practice address
190 N MAIN ST, PLYMOUTH, MI 48170-1236
(734) 416-3341
(734) 416-3345
Mailing address
190 N MAIN ST, PLYMOUTH, MI 48170-1236
(734) 416-3341
(734) 416-3345
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
AB059736
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8008911330
BLUE CROSS
MI
Enumeration date
05/17/2012
Last updated
05/17/2012
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