Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 4301056302 | MI |
NPI | 1275545634 |
---|---|
Provider Name | Dr. Michael Scott Mersol-Barg |
First Address | Bloomfield, MI 48302-1029 |
Second Address | Bloomfield Hills, MI 48304-5130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1606332721 | BLUE CROSS BLUE SHIELD MI (01) | MI |
E78136 | (02) | MI |