Provider Demographics
NPI:1023083045
Name:WILLE, BRADLEY ROBERT (MD)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:ROBERT
Last Name:WILLE
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 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5201
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:1645 LYNDALE AVE N STE 103
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-2935
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:651-968-5904
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32450207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP14694OtherHEALTH PARTNERS
MN200001863Medicare ID - Type UnspecifiedMEDICARE
MN0918112OtherMEDICA, FARIBAULT
MN105690C572OtherUCARE MN
MN200010213Medicare ID - Type UnspecifiedPALMETTO GBA, RR MC
MN812297100Medicaid
MN20621WIOtherBCBS OF MN
MN983181004378OtherPREFERRED ONE
MN0918111OtherMEDICA, NORTHFIELD
MNE54721Medicare UPIN