Provider Demographics
NPI:1437218328
Name:BLEECKER, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:BLEECKER
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 1:1133 E STANLEY BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4200
Mailing Address - Country:US
Mailing Address - Phone:925-447-1010
Mailing Address - Fax:925-447-0736
Practice Address - Street 1:1133 E STANLEY BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4200
Practice Address - Country:US
Practice Address - Phone:925-447-1010
Practice Address - Fax:925-447-0736
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16234207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G162340Medicaid
CAA39741Medicare UPIN
CA00G162340Medicaid