Provider Demographics
NPI:1568402139
Name:JAVORSKY, BRADLEY RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:RICHARD
Last Name:JAVORSKY
Suffix:
Gender:M
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:W129N7055 NORTHFIELD DR
Mailing Address - Street 2:ENDOCRINOLOGY CLINIC
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0538
Mailing Address - Country:US
Mailing Address - Phone:262-253-7155
Mailing Address - Fax:262-253-7140
Practice Address - Street 1:W129N7055 NORTHFIELD DR
Practice Address - Street 2:ENDOCRINOLOGY CLINIC
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0538
Practice Address - Country:US
Practice Address - Phone:262-253-7155
Practice Address - Fax:262-253-7140
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51791207RE0101X, 207RE0101X
VA0101238134207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004900090Medicaid
WI1568402139Medicaid
VA008984C61Medicare ID - Type Unspecified
WI116173601Medicare PIN
WI1568402139Medicaid
VA004900090Medicaid