BRADLEY JAY WILSON


Address: 11800 E 12 Mile Rd, Warren, MI 48093-3472
Phone: 5865735060

BRADLEY JAY WILSON (NPI# 1174810824) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1174810824
Entity Type Individual
Full Name BRADLEY JAY WILSON
Credential M.D.
Practice Address 11800 E 12 Mile Rd
Warren
MI 48093-3472
Mailing Address 11800 East 12 Mile Road
Warren
MI 48093
Practice Telephone 5865735060
Mailing Telephone 5865735060
Enumeration Date 2011-07-01
Last Update Date 2018-03-17
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 2085B0100X Radiology
Specialization: Body Imaging
4301098675 MI Allopathic & Osteopathic Physicians
N 2085R0202X Radiology
Specialization: Diagnostic Radiology
4301097675 MI Allopathic & Osteopathic Physicians
Y 2085R0202X Radiology
Specialization: Diagnostic Radiology
4301098675 MI Allopathic & Osteopathic Physicians

Provider Secondary Practice Location

Address Telephone Number Fax Number
3601 W 13 Mile Rd, Royal Oak, MI 480736712 2486759014

Other Providers BRADLEY WILSON

NPI Name Taxonomy Address Enumeration
1235519984 Bradley Craig Wilson Military Health Care Provider 2807 Montclair Ave, Pascagoula, MS 39567-5287 2015-06-08
1699061598 Bradley Paul Wilson Student in an Organized Health Care Education/Training Program 349 17th Ave, San Francisco, CA 94121-2312 2011-06-20
1407084791 Bradley Allen Wilson Urology 500 E Robinson Suite 1300, Norman Urology Associates, PC, Norman, OK 73071-6694 2009-06-25
1053329185 Bradley Rix Wilson Dentist 2077 S Gessner Rd, Suite 125, Houston, TX 77063-1147 2006-08-04
1528046141 Bradley A Wilson Surgery 1000 Health Center Dr Ste 101, Mattoon, IL 61938-4644 2006-01-04
1225020878 Bradley C Wilson Family Medicine 7756 State Route 37 E, New Lexington, OH 43764-9512 2005-08-19
1366078990 Bradley Clark Wilson Case Manager/Care Coordinator 2005 Ashland Ave, Toledo, OH 43620-1703 2020-03-16
1508339987 Bradley Russell Wilson Nurse Practitioner 22101 Moross Rd, Detroit, MI 48236-2148 2019-01-08
1386985133 Bradley W Wilson Nurse Anesthetist, Certified Registered 300 North Ave, Battle Creek, MI 49017-3307 2013-03-04
1609130954 Bradley Lyle Wilson Family Medicine 4771 S Cleveland Ave, Fort Myers, FL 33907 2012-07-02

Office Location

Street Address 11800 E 12 MILE RD
City WARREN
State MI
Zip Code 48093-3472

Providers in the same location

NPI Name Taxonomy Address Enumeration
1740280940 Manisha Kaur Bajwa Pharmacist 11800 E 12 Mile Rd, Pharmacy Department, Warren, MI 48093-3472 2005-07-28
1679181986 Roxana Lionte Nurse Practitioner 11800 E 12 Mile Rd, Warren, MI 48093-3472 2020-07-22
1649893355 Patrick Yang Student in an Organized Health Care Education/Training Program 11800 E 12 Mile Rd, Warren, MI 48093-3472 2020-05-28
1831711936 Elisheva Ellenberg Nurse Practitioner 11800 E 12 Mile Rd, Warren, MI 48093-3472 2020-05-12
1427686716 Pavan Kumar Ravipati Student in an Organized Health Care Education/Training Program 11800 E 12 Mile Rd, Warren, MI 48093-3472 2020-03-31
1962038885 Natasha Mehta Student in an Organized Health Care Education/Training Program 11800 E 12 Mile Rd, Warren, MI 48093-3472 2020-03-23
1194350645 Katherine Sara Streidl Nurse Anesthetist, Certified Registered 11800 E 12 Mile Rd, Warren, MI 48093-3472 2020-03-05
1891326898 Clara Poparad-stezar Student in an Organized Health Care Education/Training Program 11800 E 12 Mile Rd, Warren, MI 48093-3472 2020-01-28
1023653797 Lauren Ashley Shailor Nurse Practitioner 11800 E 12 Mile Rd, Warren, MI 48093-3472 2019-11-16
1700428984 Olivia Lynn Hedman Dietitian, Registered 11800 E 12 Mile Rd, Warren, MI 48093-3472 2019-10-09
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1023615986 Toleka Regina Taylor Nurse Anesthetist, Certified Registered St. John Macomb Hospital, 11800 East 12 Mile Road, Warren, MI 48093 2020-10-05
1679112676 Open Heart Communities Case Management 31310 Shaw Dr, Warren, MI 48093 2019-12-23
1538715636 3 Dove Medical Supplies Durable Medical Equipment & Medical Supplies 31201 Chicago Rd S Ste C101, Warren, MI 48093 2019-08-14
1568954600 Schreiber Cardiology, P.C. Internal Medicine 8545 Common Rd Ste 150, Warren, MI 48093 2018-06-05
1730686197 Lambro Seremetis Social Worker 12200 E. 12 Mile Road, Ste. 200, Warren, MI 48093 2018-04-11
1649775826 Ridge Downs Behavioral Analyst 31201 Chicago Rd South, Suite C- 202, Warren, MI 48093 2018-03-28
1144722737 Jessica Farraj Occupational Therapist 11800 E. 12 Mile Road, Warren, MI 48093 2018-02-28
1265930168 Leah Hanrahan Registered Nurse 11700 Amberle Dr., Warren, MI 48093 2018-01-25
1598271553 Pamela Marie Confer Occupational Therapist 11012 13 Mile Rd, Suite 200, Warren, MI 48093 2017-12-28
1831604347 Kate Jeanne Szczepanski Behavior Technician 31200 Chicago Rd S, Warren, MI 48093 2017-12-06
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Taxonomy Information

Taxonomy Code 2085R0202X
Grouping Allopathic & Osteopathic Physicians
Classification Radiology
Specialization Diagnostic Radiology

Taxonomy Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1497959183 Bi-county Physicians Practices Radiology 13355 East 10 Mile Road, Warren, MI 48089-2048 2007-06-14
1013070135 Mcnichols Xray Clinic PC Radiology 21230 Dequindre Road, Southeast Michigan Surgical Hospital, Warren, MI 48091 2006-12-19
1598786451 Walter H Kuhnen Radiology 2 12 Crescent Park, Warren, PA 16365 2006-07-23
1457370330 Neha Kothari Radiology 9 Cotswold Ln, Warren, NJ 07059-6900 2006-07-19
1871518449 Radiology Specialties PC Radiology 13355 East Ten Mile Rd, Warren, MI 48089-1240 2006-07-13
1477578144 Diagnostic Radiology Consultants PC Radiology 11800 E Twelve Mile Road, St John Macomb Hospital, Warren, MI 48093 2006-07-13
1144263153 Franklin D Wald Radiology 9 Nottingham Way, Warren, NJ 07059-6754 2006-06-14
1881651909 Robert Palmer Stecher Radiology 2900 Sandpiper Trl Se, Warren, OH 44484-5706 2006-05-01
1972586717 Great Lakes Mri of Michigan LLC Radiology 27301 Schoenherr Rd, Suite 100, Warren, MI 48088-6649 2005-11-25
1154319259 Medical Imaging Network Inc Radiology 5500 E Market St, Warren, OH 44484-2214 2005-10-12
Find all providers in WARREN

Competitor

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City WARREN
Zip Code 48093

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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