Provider Demographics
NPI:1184121824
Name:WOELKE, BRADFORD J (MD)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:J
Last Name:WOELKE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE SUITE J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:IHA CLARKSTON PRIMARY CARE
Practice Address - Street 2:6770 DIXIE HIGHWAY SUITE 303
Practice Address - City:CLARSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-625-0300
Practice Address - Fax:248-625-4403
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301504633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine