Individual
DR. JACOB ALEXANDER BRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
714 N MICHIGAN ST, SOUTH BEND, IN 46601-1035
(574) 647-7477
(574) 647-3655
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-6592
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02007857A
IN
207Q00000X
Family Medicine Physician
05-51049
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300091075
—
IN
Enumeration date
05/06/2021
Last updated
05/19/2025
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