Provider Demographics
NPI:1104856046
Name:BISGROVE, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:BISGROVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:555 5TH ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9730
Mailing Address - Country:US
Mailing Address - Phone:541-412-1152
Mailing Address - Fax:541-412-1842
Practice Address - Street 1:555 5TH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9730
Practice Address - Country:US
Practice Address - Phone:541-412-1152
Practice Address - Fax:541-412-1842
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101039643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine