Provider Demographics
NPI:1457516866
Name:ASHPOLE, BRADLEY LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:LANE
Last Name:ASHPOLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1333 W ESTATE LN E
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3623
Mailing Address - Country:US
Mailing Address - Phone:847-650-5818
Mailing Address - Fax:312-660-8837
Practice Address - Street 1:1107 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-1408
Practice Address - Country:US
Practice Address - Phone:847-884-8346
Practice Address - Fax:847-739-0969
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2024-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036113854208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery