Provider Demographics
NPI:1205974052
Name:FRIEDLAND, BRADLEY NEAL (DO)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:NEAL
Last Name:FRIEDLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3162
Mailing Address - Country:US
Mailing Address - Phone:616-957-1217
Mailing Address - Fax:
Practice Address - Street 1:2428 LAKE DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3162
Practice Address - Country:US
Practice Address - Phone:616-957-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010074292083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD14869OtherGROUP PTAN
MID14869126OtherMEDICARE PTAN
MI47028Medicare UPIN
MI5410385Medicare ID - Type Unspecified