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BRADLEY BLISS PAC

Medical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1114014180

Individual Registrant:
 BRADLEY  BLISS PAC
Gender: M
Sole Proprietor

Location and contact information for practice:
14477 CABERFAE HWY  WELLSTON, MI 49689-9315 US
Tel: 231-848-4777  Fax: --

Contact information for business:
14477 CABERFAE HWY  WELLSTON, MI 49689-9315 US
Tel: 231-848-4777  Fax: --

Registration Information:
NPI: 1114014180
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363AM0700XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Medical
MI5601007455

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
MICHIGAN PAC LICENSE5601001299MI01
DEA NUMBERMB0528680MI01




HEALTH CARE JOBS MI - Page 1



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