Organization
NICHOLAS BRADLEE DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS BRADLEE DPM (OWNER)
(248) 244-9565
Entity
Organization
Contact information
Practice address
1909 LIVERNOIS, TROY, MI 48083
(248) 244-9565
(248) 244-8183
Mailing address
PO BOX 1029, TROY, MI 48099-1029
(248) 244-9565
(248) 244-8183
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
NB000558
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5635277
BLUE CROSS BLUE SHIELD
—
01
—
8505050
BLUE SHIELD OF MICH
—
Enumeration date
08/20/2006
Last updated
11/20/2012
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