Provider Demographics
NPI:1497749873
Name:BERNATH, GREGORY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:BERNATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4918
Practice Address - Country:US
Practice Address - Phone:616-392-3824
Practice Address - Fax:616-494-5950
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052125207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382074554OtherTAX ID
MI060F16016OtherBCBS
MI0F16016004Medicare ID - Type Unspecified
MI1842528Medicaid
MI382125186OtherTAX ID FOR WEST MICHIGAN HEART
MIB48913OtherPRIORITY HEALTH
MI060F160160OtherBLUE CARE NETWORK
MIGB052125OtherBCBS INDIVIDUAL
MIB48913Medicare UPIN
MI382074554109Medicaid
MI060010764Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI101842528Medicaid