Provider Demographics
NPI:1851533277
Name:BERNARDIN, MICHEL CLEMENT
Entity Type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:CLEMENT
Last Name:BERNARDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:CHUCKEY
Mailing Address - State:TN
Mailing Address - Zip Code:37641-0235
Mailing Address - Country:US
Mailing Address - Phone:423-329-2276
Mailing Address - Fax:
Practice Address - Street 1:179 LAUREL ESTATES CIR
Practice Address - Street 2:
Practice Address - City:CHUCKEY
Practice Address - State:TN
Practice Address - Zip Code:37641-6157
Practice Address - Country:US
Practice Address - Phone:423-329-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle