Provider Demographics
NPI:1861646267
Name:BRADSHAW, MICHAEL B (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9878 HIBERT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1020
Mailing Address - Country:US
Mailing Address - Phone:858-693-3000
Mailing Address - Fax:858-693-3700
Practice Address - Street 1:9878 HIBERT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1020
Practice Address - Country:US
Practice Address - Phone:858-693-3000
Practice Address - Fax:858-693-3700
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA118993207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology