Provider Demographics
NPI:1710069729
Name:BERNSTEIN, RANDY HARVEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:HARVEY
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10986 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3058
Mailing Address - Country:US
Mailing Address - Phone:313-274-7047
Mailing Address - Fax:313-274-7032
Practice Address - Street 1:10986 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3058
Practice Address - Country:US
Practice Address - Phone:313-274-7047
Practice Address - Fax:313-274-7032
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001223213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5821447OtherBCBS OF MI
MI9958TYPE13Medicaid
MI6142480001Medicare NSC
MI9958TYPE13Medicaid