| Doctor Name: | BRADLEY D BASTOW |
| NPI Number: | 1346221082 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 5101008849 |
| Business Practice Address: | 950 Blue Star Hwy Suite 1-2 South Haven, MI - 490907759 |
| Business Phone Number: | 2696371388 |
| Business Fax Number: | 2696371459 |
| Mailing Address: | 950 Blue Star Hwy, Suite 1-2 SOUTH HAVEN |
| State: | MI |
| Postal Code: | 490907759 |
| Phone Number: | 2696371388 |
| Fax Number: | 2696371459 |
| NPI Enumeration Date: | 11/09/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RC0000X |
| License Number: | 5101008849 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Cardiovascular Disease |
| Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |