Individual
BRADEN CRAGG RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
12563 STATE ROAD 23, GRANGER, IN 46530-9226
(574) 277-2090
(574) 277-2175
Mailing address
707 E CEDAR ST, STE 200, SOUTH BEND, IN 46617-2057
(574) 335-8700
(574) 335-0760
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000713
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215219
BCBS
IN
05
—
100092920A
—
IN
Enumeration date
06/14/2006
Last updated
01/03/2020
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