Provider Demographics
NPI:1811939242
Name:ROEHR, BERNARD A (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:A
Last Name:ROEHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M424
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-3350
Mailing Address - Fax:269-349-2403
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-424
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-3350
Practice Address - Fax:269-349-2403
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051166207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200C911390OtherBCBS GRP PIN
MI1811939242Medicaid
4366534OtherAETNA PIN
MI2003904251OtherBCBS IND PIN
MI4738176-10Medicaid
MI1811939242Medicaid
383148262OtherEIN-HEALTHCARE MIDWEST
MI200C911390OtherBCBS GRP PIN
MI0C97618273Medicare PIN
MI4738176-10Medicaid
MI1811939242Medicaid