Provider Demographics
NPI:1134665011
Name:TODD, BRADLEY (PA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:TODD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 LAPEER AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1203
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:229 GALLAGHER ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-3252
Practice Address - Country:US
Practice Address - Phone:989-755-3619
Practice Address - Fax:989-755-3624
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant