Provider Demographics
NPI:1710107701
Name:BRADFORD, JOYCE DENISE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:DENISE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:D
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2000 TOWN CTR
Mailing Address - Street 2:STE 1900
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1152
Mailing Address - Country:US
Mailing Address - Phone:248-565-4024
Mailing Address - Fax:775-587-3115
Practice Address - Street 1:2000 TOWN CTR STE 1900
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1152
Practice Address - Country:US
Practice Address - Phone:248-565-4024
Practice Address - Fax:775-587-3115
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001148213ES0000X, 213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5635120Medicare PIN
MIT34158Medicare UPIN