Provider Demographics
NPI:1164505772
Name:BRADLEY, KAREN ANNIE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNIE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 606
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3424
Mailing Address - Country:US
Mailing Address - Phone:440-895-0270
Mailing Address - Fax:440-895-0272
Practice Address - Street 1:20525 CENTER RIDGE RD
Practice Address - Street 2:SUITE 606
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3424
Practice Address - Country:US
Practice Address - Phone:440-895-0270
Practice Address - Fax:440-895-0272
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350512032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH570314Medicaid
OHBR0559871Medicare ID - Type Unspecified
A15920Medicare UPIN