Bradshaw Michael Mallard PA

NPI 1003095548 - Physician Assistant - 363AM0700X

NPI Details
NPI 1003095548
Gender Male
Enumeration Date 11/01/2007
Last Updated 06/07/2016
Entity Type Individual
Active Over 9 years ago
Practice Location
21801 GODDARD RD
WSUPG PM&R OAKWOOD
TAYLOR MI, 48180-4213, US
Phone (313) 438-7373
Fax (313) 438-7375
Business Location
1560 E. MAPLE RD.
SUITE 400- CREDENTIALING
TROY MI, 48083-1189, US
Phone (734) 284-0865
Fax (248) 581-5640
Toxanomy
Taxonomy Code 363AM0700X
License State Michigan
License Number 5601001586
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According to our database, Bradshaw Michael Mallard PA NPI is 1003095548, taxonomy code is 363AM0700X and license number is 5601001586, license state is located at Michigan. Bradshaw Michael Mallard PA physically located at 21801 Goddard Rd, Taylor MI, 48180-4213. NPI Number Bradshaw Michael Mallard PA has the Individual type.

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1003095548 NPI number is provided on an as is basis without warranty of any kind. 1003095548 is maintained by the National Plan & Provider Enumeration System. The contents of Bradshaw Michael Mallard PA are for informational purposes only.