Provider Demographics
NPI:1275545634
Name:MERSOL-BARG, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:MERSOL-BARG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2830 MEADOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1029
Mailing Address - Country:US
Mailing Address - Phone:248-972-0877
Mailing Address - Fax:
Practice Address - Street 1:41000 WOODWARD AVE
Practice Address - Street 2:SUITE 100 EAST
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5130
Practice Address - Country:US
Practice Address - Phone:248-593-6990
Practice Address - Fax:248-593-5925
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056302207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1606332721OtherBLUE CROSS BLUE SHIELD MI
MIE78136Medicare UPIN