Provider Demographics
NPI:1255189056
Name:BRADFORD, MITCHELL
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CARNEGIE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2338
Mailing Address - Country:US
Mailing Address - Phone:216-260-1366
Mailing Address - Fax:
Practice Address - Street 1:2020 CARNEIGE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2338
Practice Address - Country:US
Practice Address - Phone:216-260-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management