Provider Demographics
NPI:1659319721
Name:FINE, BRADFORD MARTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:MARTIN
Last Name:FINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:C115
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-8855
Mailing Address - Fax:859-278-8856
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:C115
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-8855
Practice Address - Fax:859-278-8856
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00313213ES0103X, 213E00000X
FLPO3163213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100003410Medicaid
KY80900061OtherMEDICAID GROUP
KY6569OtherMEDICARE GROUP
KY0656909Medicare PIN