Provider Demographics
NPI:1306858980
Name:THOMAS J W BERING, MD, PC
Entity Type:Organization
Organization Name:THOMAS J W BERING, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-795-1390
Mailing Address - Street 1:2311 15 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4812
Mailing Address - Country:US
Mailing Address - Phone:586-795-1390
Mailing Address - Fax:586-795-1395
Practice Address - Street 1:2311 15 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4812
Practice Address - Country:US
Practice Address - Phone:586-795-1390
Practice Address - Fax:586-795-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITB057582207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3517180Medicaid
G12315Medicare UPIN
0M74380Medicare ID - Type Unspecified