Provider Demographics
NPI:1912747999
Name:SLEDGE, BRAD CLAUD I
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:CLAUD
Last Name:SLEDGE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-2921
Mailing Address - Country:US
Mailing Address - Phone:313-932-9732
Mailing Address - Fax:
Practice Address - Street 1:3747 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2921
Practice Address - Country:US
Practice Address - Phone:313-932-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker