Provider Demographics
NPI:1194216218
Name:MARTINO, BRADLEY A (DO)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:MARTINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17012 BIRCHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NUNICA
Mailing Address - State:MI
Mailing Address - Zip Code:49448-9359
Mailing Address - Country:US
Mailing Address - Phone:775-223-4503
Mailing Address - Fax:
Practice Address - Street 1:1091 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2607
Practice Address - Country:US
Practice Address - Phone:616-604-0096
Practice Address - Fax:616-604-0095
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine