Provider Demographics
NPI:1265860878
Name:BRADLEY, MICHAEL S (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:404 SHOPPERS DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1301
Mailing Address - Country:US
Mailing Address - Phone:859-737-5333
Mailing Address - Fax:859-737-0070
Practice Address - Street 1:1138 LEXINGTON RD STE 110
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9673
Practice Address - Country:US
Practice Address - Phone:502-570-3754
Practice Address - Fax:502-570-3756
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYPA1825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100277800Medicaid
KYK095332Medicare PIN