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Individual

BRADLEY W MILLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
401 W MILL ST, BONDUEL, WI 54107-9246
(715) 758-2167
(715) 758-6701
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7229

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2659
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1093846
NATIONAL COMMISSION ON CERTIFIED PHYSICIANS ASSISTANTS
Enumeration date
09/14/2010
Last updated
07/30/2020
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