Provider Demographics
NPI:1760431555
Name:MAXFIELD, BRADLEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:MAXFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 ELDORADO CT
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2672
Mailing Address - Country:US
Mailing Address - Phone:262-227-0751
Mailing Address - Fax:
Practice Address - Street 1:1408 ELDORADO CT
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2672
Practice Address - Country:US
Practice Address - Phone:262-227-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI369992085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology