Provider Demographics
NPI:1356307052
Name:BLEIBERG, MARVIN N (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:N
Last Name:BLEIBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8931
Mailing Address - Country:US
Mailing Address - Phone:989-772-1609
Mailing Address - Fax:989-773-6279
Practice Address - Street 1:2480 W CAMPUS DR
Practice Address - Street 2:STE 500
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-772-1609
Practice Address - Fax:989-773-6279
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010644772081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1174698336Medicaid
MIDD1273OtherMEDICARE RAILROAD GROUP
MI1487796504Medicaid
MI1174698336Medicaid
MI1487796504Medicaid