Individual
BRADLEY T VANASSCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1114 CHARLEVOIX AVE, PETOSKEY, MI 49770-9701
(231) 439-9700
(231) 439-9709
Mailing address
1114 CHARLEVOIX AVE, PETOSKEY, MI 49770-9701
(231) 439-9700
(231) 439-9709
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
4301055847
MI
2085R0202X
Diagnostic Radiology Physician
Primary
BV055847
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300Z460020
BLUE CROSS
MI
05
—
3152928
—
MI
01
—
P00957391
RR MEDICARE PTAN
MI
Enumeration date
07/20/2006
Last updated
10/17/2019
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