Provider Demographics
NPI:1568682508
Name:BRADLEY, TIMOTHY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:BRADLEY
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 1:3310 W MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1000
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:3310 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1000
Practice Address - Country:US
Practice Address - Phone:630-897-6044
Practice Address - Fax:630-659-3502
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0829712086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-082971Medicaid
IL036-082971Medicaid
IL0727500002Medicare NSC