Provider Demographics
NPI:1861598682
Name:MIKAELIAN, BRADLEY JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JAMES
Last Name:MIKAELIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:JAMES
Other - Last Name:QUIRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-624-4443
Mailing Address - Fax:970-490-4175
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:SUITE 700
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-635-7172
Practice Address - Fax:719-444-3759
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223227207R00000X
CO47545207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64684041Medicaid
COCO306693Medicare PIN
CO264010YLB8Medicare PIN
CO304228Medicare PIN