Individual
AMY L BRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
44555 WOODWARD AVE, SUITE 206, PONTIAC, MI 48341
(248) 338-7171
(248) 858-3830
Mailing address
44555 WOODWARD AVE, SUITE 206, PONTIAC, MI 48341
(248) 338-7171
(248) 858-3830
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301074104
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0206348782
BCBSM
—
05
—
4736387
—
MI
01
—
AB074104
STATE LICENSE
—
Enumeration date
11/07/2006
Last updated
07/08/2007
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