Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | JB047245 | MI |
NPI | 1184664302 |
---|---|
Provider Name | Dr. John J. Bernick |
First Address | Dearborn, MI 48124-2107 |
Second Address | Dearborn, MI 48124-2107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 03/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02507830130 | AMERICAN MEDICAL ASSO. (01) | MI |
0822360 | BLUE CROSS BLUE SHIELD (01) | MI |
BB5448798 | DEA NUMBER (01) | MI |
E49608 | (02) | MI |
JB047245 | LICENSE NUMBER (01) | MI |