Individual
MR. BRADLEY ANTHONY QUALIZZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
85 E US HIGHWAY 6, VALPARAISO, IN 46383-8947
(219) 983-8300
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002518A
IN
Other
Enumeration date
06/18/2018
Last updated
09/28/2018
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