Provider Demographics
NPI:1710075494
Name:BIGLEY, BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:BIGLEY
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 1:80650 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:MI
Mailing Address - Zip Code:48065-1333
Mailing Address - Country:US
Mailing Address - Phone:810-798-6410
Mailing Address - Fax:
Practice Address - Street 1:80650 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MI
Practice Address - Zip Code:48065-1333
Practice Address - Country:US
Practice Address - Phone:810-798-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301023725261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB49324Medicare UPIN