Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 4301064477 | MI |
N | 2081P2900X | Pain Medicine | 4301064477 | MI |
NPI | 1356307052 |
---|---|
Provider Name | Marvin N Bleiberg |
First Address | Mt Pleasant, MI 48858 |
Second Address | Mt Pleasant, MI 48858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2006 |
Last Update Date | 25/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174698336 | (05) | MI |
1487796504 | (05) | MI |
DD1273 | MEDICARE RAILROAD GROUP (01) | MI |
F87848 | (02) |