Bradley Bengtson, M.D. PC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

4301407033 Issued in MI

Legal business name

BRADLEY BENGTSON, M.D. PC

Doing business as

Bengtson Center for Aesthetics and Plastic Surgery

Practice address

555 Midtowne St NE
Suite 110
Grand Rapids, MI 49503-5729

Phone

(616) 588-8880

Fax

(616) 588-8881

NPI assigned

Apr 21, 2010

Last updated

Apr 21, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bradley Bengtson, M.D., FACS

Title

Owner

Phone

(616) 588-8880

Specialties & licenses 1

Addresses

Other names 1

• Bengtson Center for Aesthetics and Plastic Surgery Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katrina Ann Brummel, PA-C

  • Physician Assistant
  • Grand Rapids, MI
  • NPI 1174029094
  NPD (past)
• Roxanne Kay Cornelius, PA-C

  • Medical Physician Assistant
  • Grand Rapids, MI
  • NPI 1467798231
  NPD (past)
• Meredith Kent, PA

  • Medical Physician Assistant
  • Grand Rapids, MI
  • NPI 1790986917
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271808000000",
    "number": "1013234707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 MIDTOWNE ST NE",
            "address_2": "SUITE 110",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035729",
            "telephone_number": "616-588-8880",
            "fax_number": "616-588-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 MIDTOWNE ST NE",
            "address_2": "SUITE 110",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035729",
            "telephone_number": "616-588-8880",
            "fax_number": "616-588-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY BENGTSON, M.D. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-21",
        "last_updated": "2010-04-21",
        "status": "A",
        "authorized_official_last_name": "BENGTSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-588-8880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., FACS"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MI",
            "license": "4301407033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bengtson Center for Aesthetics and Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ellen Lee Bradbury
• Jonathan Edward Bradd, NP
• Mark David Braden Jr., DO
• Nikia Joy Braden
• Alyssa Bradfield, DO
• Bradley J Redeker, LMSW, LLC
• Abigail Marie Bradley, LMSW
• Amanda Jo Bradley, LPN
• Barbara J Bradley, MD
• Erica Lynn Bradley, LMSW

• Plastic Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Plastic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.