Provider Demographics
NPI:1619957370
Name:BIELFELT, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:BIELFELT
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 1:21298 OLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6705
Mailing Address - Country:US
Mailing Address - Phone:941-624-7032
Mailing Address - Fax:
Practice Address - Street 1:4300 N ACCESS RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3812
Practice Address - Country:US
Practice Address - Phone:423-826-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS56422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271113300Medicaid
FL13780OtherBCBS FL
OHBI4260371Medicare PIN
FL271113300Medicaid
FL13780OtherBCBS FL
FL13780ZMedicare ID - Type Unspecified