Bradley, Stephen Jerome
Bradley, Stephen Jerome is an individual health care provider with primary practice located at 4160 John R St Ste 615, Detroit MI 48201-2020. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Surgical Critical Care. Allopathic & Osteopathic Physicians / Surgical Critical Care is his primary health care specialty. Bradley, Stephen Jerome can be contacted via phone (313) 745-4195.Contact Information
Primary practice address
4160 John R St Ste 615
Detroit MI 48201-2020
Phone: (313) 745-4195
Fax: (313) 745-8669
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 4301050040 | Michigan |
| Allopathic & Osteopathic Physicians / Surgical Critical Care | 2086S0102X | 4301050040 | Michigan |
Profile Details
| NPI number | 1164455028 |
|---|---|
| LBN Legal business name | Bradley, Stephen Jerome |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 7th, 2006 |
| Last updated | Oct 17th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164455028 | NPPES |
| Wisconsin | MEDICAID | 31523400 | |
| Wisconsin | Other | 020017324 | |
| Wisconsin | MEDICAID | 036078462 |
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