Provider Demographics
NPI:1508062589
Name:MICHAEL J BIELEFELD MD LLC
Entity Type:Organization
Organization Name:MICHAEL J BIELEFELD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIELEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-436-8200
Mailing Address - Street 1:501 VAN BUREN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1534
Mailing Address - Country:US
Mailing Address - Phone:419-436-8200
Mailing Address - Fax:419-436-0077
Practice Address - Street 1:501 VAN BUREN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1534
Practice Address - Country:US
Practice Address - Phone:419-436-8200
Practice Address - Fax:419-436-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-6329B208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0977126Medicaid
OH0977126Medicaid