Provider Demographics
NPI:1629605654
Name:BRADT, BARENT (DO)
Entity type:Individual
Prefix:
First Name:BARENT
Middle Name:
Last Name:BRADT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:235 WEALTHY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5247
Mailing Address - Country:US
Mailing Address - Phone:616-840-7135
Mailing Address - Fax:
Practice Address - Street 1:550 MUNSON AVE STE M100
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3593
Practice Address - Country:US
Practice Address - Phone:231-935-8604
Practice Address - Fax:231-392-7333
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101026995208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation