Provider Demographics
NPI:1245419464
Name:BRADLEY, KIM KATHERINE
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:KATHERINE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 TRUMBULL AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-4532
Mailing Address - Country:US
Mailing Address - Phone:630-660-6081
Mailing Address - Fax:
Practice Address - Street 1:8211 TRUMBULL AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-4532
Practice Address - Country:US
Practice Address - Phone:630-660-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist