Provider Demographics
NPI:1578737060
Name:GERALD P BERNER MD PC
Entity Type:Organization
Organization Name:GERALD P BERNER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-2585
Mailing Address - Street 1:G3500 FLUSHING RD STE 550
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4236
Mailing Address - Country:US
Mailing Address - Phone:810-733-2585
Mailing Address - Fax:
Practice Address - Street 1:G3500 FLUSHING RD STE 550
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4236
Practice Address - Country:US
Practice Address - Phone:810-733-2585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010237432080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1001808Medicaid
MI3502512991OtherBCBS/BCNEM
MI1002546OtherMCLAREN HEALTHPLAN
MI3506912OtherHEALTHPLUS OF MICHIGAN