Provider Demographics
NPI:1518739598
Name:BRADFORD, MICAH
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2783 SALEM HILLS CT
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9517
Mailing Address - Country:US
Mailing Address - Phone:614-432-3340
Mailing Address - Fax:
Practice Address - Street 1:2783 SALEM HILLS CT
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9517
Practice Address - Country:US
Practice Address - Phone:614-432-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company