Provider Demographics
NPI:1003890864
Name:BIERNAT, BOZENA J (MD)
Entity Type:Individual
Prefix:
First Name:BOZENA
Middle Name:J
Last Name:BIERNAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 REDBIRD CIR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7977
Mailing Address - Country:US
Mailing Address - Phone:920-338-6870
Mailing Address - Fax:
Practice Address - Street 1:555 REDBIRD CIR
Practice Address - Street 2:SUITE 300
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-7977
Practice Address - Country:US
Practice Address - Phone:920-338-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI072250045Medicare Oscar/Certification
WI073050052Medicare Oscar/Certification
WIG68466Medicare UPIN
WI002150166Medicare Oscar/Certification
WI002150005Medicare Oscar/Certification
WI071700059Medicare Oscar/Certification
WI100200059Medicare Oscar/Certification
WI590050063Medicare Oscar/Certification
WI072900054Medicare Oscar/Certification
WI075100106Medicare Oscar/Certification
WI005907355Medicare Oscar/Certification