Provider Demographics
NPI:1720047889
Name:BERNARD, SETH RAYMOND (DO)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:RAYMOND
Last Name:BERNARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30 W MONROE ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2420
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:3525 SAGINAW RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529
Practice Address - Country:US
Practice Address - Phone:810-222-3040
Practice Address - Fax:810-958-1176
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5254777OtherBCBS
MI3524166Medicaid
F47335Medicare UPIN
MI5254777OtherBCBS