Provider Demographics
NPI:1861503492
Name:BIALOR, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:BIALOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24100 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2819
Mailing Address - Country:US
Mailing Address - Phone:248-559-3400
Mailing Address - Fax:248-557-5580
Practice Address - Street 1:24100 SOUTHFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2819
Practice Address - Country:US
Practice Address - Phone:248-559-3400
Practice Address - Fax:248-557-5580
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301065347207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF74760Medicare UPIN
MIM12080032Medicare ID - Type Unspecified