Organization
NICHOLAS BRADLEE DPM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS BRADLEE DPM (OWNER)
(586) 751-3533
Entity
Organization
Contact information
Practice address
28565 RYAN ROAD, WARREN, MI 48092
(586) 751-3533
(586) 751-1817
Mailing address
PO BOX 1227, WARREN, MI 48090-1227
(586) 751-3533
(586) 751-1817
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
NB000558
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5635277
BLUE CROSS BLUE SHIELD
MI
01
—
8505050
BLUE CROSS BLUE SHIELD
MI
Enumeration date
10/27/2006
Last updated
08/22/2020
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