Provider Demographics
NPI:1871585307
Name:WOELKE, BRADFORD J (MD)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:J
Last Name:WOELKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6620 HIGHLAND RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327
Mailing Address - Country:US
Mailing Address - Phone:248-666-9332
Mailing Address - Fax:248-666-0340
Practice Address - Street 1:6620 HIGHLAND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327
Practice Address - Country:US
Practice Address - Phone:248-666-9332
Practice Address - Fax:248-666-0340
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301041120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1788924Medicaid
0F36313002Medicare ID - Type UnspecifiedWOELKE MC PIN
0F363139011Medicare ID - Type UnspecifiedMEDICARE
MIA73313Medicare UPIN