Provider Demographics
NPI:1003446477
Name:BRADLEY, ROSSLEY
Entity Type:Individual
Prefix:
First Name:ROSSLEY
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 EAGLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1873
Mailing Address - Country:US
Mailing Address - Phone:708-691-6123
Mailing Address - Fax:855-918-1906
Practice Address - Street 1:4557 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2354
Practice Address - Country:US
Practice Address - Phone:855-494-2600
Practice Address - Fax:855-918-1906
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography