Provider Demographics
NPI:1700085537
Name:BRADLEY W. MAYS, M.D., S.C.
Entity Type:Organization
Organization Name:BRADLEY W. MAYS, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:WOLFE
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-967-8786
Mailing Address - Street 1:2015 E NEWPORT AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2949
Mailing Address - Country:US
Mailing Address - Phone:414-967-8786
Mailing Address - Fax:414-961-0335
Practice Address - Street 1:2015 E NEWPORT AVE STE 305
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2949
Practice Address - Country:US
Practice Address - Phone:414-967-8786
Practice Address - Fax:414-961-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34244208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32552400Medicaid
WIG92885Medicare UPIN