Provider Demographics
NPI:1346251527
Name:BISHOP, MICHAEL E (DC, MPAS, MBA, PA-C)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DC, MPAS, MBA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40520 COUNTY HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:OGEMA
Mailing Address - State:MN
Mailing Address - Zip Code:56569-9612
Mailing Address - Country:US
Mailing Address - Phone:218-983-4300
Mailing Address - Fax:218-983-6307
Practice Address - Street 1:2471 310TH AVENUE
Practice Address - Street 2:
Practice Address - City:MAHNOMEN
Practice Address - State:MN
Practice Address - Zip Code:56557
Practice Address - Country:US
Practice Address - Phone:218-935-2238
Practice Address - Fax:218-935-5085
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10779363A00000X
ND694111N00000X
MN4088111N00000X
MN1435363A00000X
NDPAC0588363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDBIS20056OtherHILLSBORO NDBCBS IND ID
MN39D57BIOtherHILLSBORO MN BCBS IND ID
MN529P8BIOtherNOKKEN BCBSMN IND ID
MNBIS26390OtherNOKKEN BCBSND IND ID
MN529P8BIOtherNOKKEN BCBSMN IND ID
MN39D57BIOtherHILLSBORO MN BCBS IND ID
ND20056Medicare ID - Type UnspecifiedND MEDICARE #
MN500685600Medicaid