Provider Demographics
NPI:1710487095
Name:BRADLEY ASHPOLE MD LLC
Entity Type:Organization
Organization Name:BRADLEY ASHPOLE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHPOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-884-8346
Mailing Address - Street 1:1333 W ESTATE LN E
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3623
Mailing Address - Country:US
Mailing Address - Phone:847-650-5818
Mailing Address - Fax:
Practice Address - Street 1:501 W GOLF RD STE A
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3502
Practice Address - Country:US
Practice Address - Phone:847-884-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113854208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty