Provider Demographics
NPI:1376730275
Name:BERNARDI, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BERNARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:310 E BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1745
Mailing Address - Country:US
Mailing Address - Phone:502-585-5249
Mailing Address - Fax:502-585-5251
Practice Address - Street 1:310 E BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1745
Practice Address - Country:US
Practice Address - Phone:502-585-5249
Practice Address - Fax:502-585-5251
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY44087207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
207N00000XOtherTAXONOMY
KY44087OtherSTATE LICENSE