Provider Demographics
NPI:1568408615
Name:BRADLEY, RONALD H (DO PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:H
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:DO PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-583-6830
Mailing Address - Fax:989-583-6994
Practice Address - Street 1:1000 HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5303
Practice Address - Country:US
Practice Address - Phone:989-583-6830
Practice Address - Fax:989-583-6994
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB0090242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2753324064OtherBLUE CROSS BLUE SHIELD
MI2905346Medicaid
MI15-21053OtherPHP
MI2905346Medicaid