Provider Demographics
NPI:1821437211
Name:BRADLEY, ASIA MAXINE (MD)
Entity Type:Individual
Prefix:
First Name:ASIA
Middle Name:MAXINE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27211 LAHSER RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8477
Mailing Address - Country:US
Mailing Address - Phone:248-234-2642
Mailing Address - Fax:
Practice Address - Street 1:27211 LAHSER RD STE 205
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8477
Practice Address - Country:US
Practice Address - Phone:248-809-1001
Practice Address - Fax:248-809-1005
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103585207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine