Provider Demographics
NPI:1790731693
Name:BRADLEE, DAVID M (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BRADLEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:43902 WOODWARD AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5011
Mailing Address - Country:US
Mailing Address - Phone:248-454-7650
Mailing Address - Fax:248-454-9794
Practice Address - Street 1:43902 WOODWARD AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5011
Practice Address - Country:US
Practice Address - Phone:248-454-7650
Practice Address - Fax:248-454-9794
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011456207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114316OtherTRINITY HEALTH
MI1818197OtherUNITED HEALTH NETWORK
MI5630444OtherBLUE CARE NETWORK
MI5630444OtherBLUE CROSS
MI0080123OtherCIGNA
MI5769622OtherAETNA
MI1225744OtherFIRST HEALTH
MI80123001OtherCIGNA PPO
MI50022409OtherHAP
MIC 6861OtherM-CARE
MI1818197OtherUNITED HEALTH NETWORK
MI80123001OtherCIGNA PPO