Provider Demographics
NPI:1639516313
Name:BRADLEY, LAURENCE MARTIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:MARTIN
Last Name:BRADLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2230 HUNTINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-4419
Mailing Address - Country:US
Mailing Address - Phone:847-603-4146
Mailing Address - Fax:847-960-3675
Practice Address - Street 1:2230 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-4419
Practice Address - Country:US
Practice Address - Phone:847-603-4146
Practice Address - Fax:847-960-3675
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.142867207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology