Provider Demographics
NPI:1598460149
Name:BAMFORD, BRAD GARRETT (DO)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:GARRETT
Last Name:BAMFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19000 ST JOES PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1477
Mailing Address - Country:US
Mailing Address - Phone:734-743-4540
Mailing Address - Fax:734-743-4541
Practice Address - Street 1:19000 ST JOES PKWY STE 310
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1477
Practice Address - Country:US
Practice Address - Phone:734-743-4540
Practice Address - Fax:734-743-4541
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program