1801278346 NPI number — DR. BRADLEY JOHN URQUHART D.O.

Table of content: DR. BRADLEY JOHN URQUHART D.O. (NPI 1801278346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801278346 NPI number — DR. BRADLEY JOHN URQUHART D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URQUHART
Provider First Name:
BRADLEY
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801278346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14604 STRAFORD CT.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-817-1550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5450 FORT STREET
Provider Second Line Business Practice Location Address:
MEDICAL EDUCATION
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-671-3297
Provider Business Practice Location Address Fax Number:
734-362-6715
Provider Enumeration Date:
06/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5101021868 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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