Provider Demographics
NPI:1487805636
Name:HARRIS, BRADLEY DORAN (CO)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:DORAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:CO
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Other - Credentials:
Mailing Address - Street 1:2215 FULLER RD.
Mailing Address - Street 2:VA MEDICAL CENTER - 121
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-769-7100
Mailing Address - Fax:734-845-3227
Practice Address - Street 1:2215 FULLER RD.
Practice Address - Street 2:VA MEDICAL CENTER - 121
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-769-7100
Practice Address - Fax:734-845-3227
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management