Individual
BRADLEY A IVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
251 E HURON ST, CHICAGO, IL 60611-2908
(312) 926-2000
Mailing address
710 W GRAND AVE UNIT 401, CHICAGO, IL 60654-5566
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-006803
IL
Other
Enumeration date
10/24/2018
Last updated
04/23/2019
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