Individual
STACE TODD BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11995 SINGLETREE LN STE 500, EDEN PRAIRIE, MN 55344-5349
(952) 595-1301
(612) 294-4903
Mailing address
11995 SINGLETREE LN STE 500, EDEN PRAIRIE, MN 55344-5349
(952) 595-1301
(612) 294-4903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
H9816
TX
2085R0202X
Diagnostic Radiology Physician
M-2194
GU
Other
Enumeration date
10/26/2005
Last updated
04/09/2021
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