Provider Demographics
NPI:1700366028
Name:BISHOP, BERNADINE ANN (DVM, MA)
Entity Type:Individual
Prefix:DR
First Name:BERNADINE
Middle Name:ANN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:DVM, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1496 DOVER HL S
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3121
Mailing Address - Country:US
Mailing Address - Phone:248-820-8969
Mailing Address - Fax:
Practice Address - Street 1:31700 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4424
Practice Address - Country:US
Practice Address - Phone:734-368-7154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017554103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical