Provider Demographics
NPI:1841282944
Name:BRADLEY, DONALD R (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-8041
Mailing Address - Country:US
Mailing Address - Phone:231-832-6670
Mailing Address - Fax:
Practice Address - Street 1:300 N PATTERSON RD
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8041
Practice Address - Country:US
Practice Address - Phone:231-832-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039106207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000494775OtherANTHEM
MI21026OtherHPM
MI04583OtherPHC
MI1606300341OtherBCBS MI
MIP00268090OtherRRMC
MI101298OtherCARE CHOICES
MI148550OtherGLHP
OH2517726Medicaid
MI4256815OtherAETNA
MI4647812Medicaid
MI4647812Medicaid