Provider Demographics
NPI:1780091546
Name:BERMUDEZ, ANGEL (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:BERMUDEZ
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-799-1350
Mailing Address - Fax:989-799-6833
Practice Address - Street 1:5275 COLONY DR N
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7157
Practice Address - Country:US
Practice Address - Phone:989-799-1350
Practice Address - Fax:989-799-6833
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301500204207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine