Basic Information
| Provider Information | |||||||||
| NPI: | 1306136288 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANGSTROM | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | GRANT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 110429 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034937000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8111 E LOWRY BLVD | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802307255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208489500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2011 | ||||||||
| LastUpdateDate: | 02/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DR.0055360 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0010X | 55360 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
No ID Information.