Provider Demographics
NPI:1639197007
Name:BIGELOW, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:BIGELOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPARTMENT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0002
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:400 HINCKLEY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-6125
Practice Address - Country:US
Practice Address - Phone:517-784-0588
Practice Address - Fax:517-784-3866
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301044701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1716152OtherCIGNA HEALTHCARE
MIP00402208OtherRR MEDICARE
MIN72760017Medicare PIN
MIP00402208OtherRR MEDICARE