Provider Demographics
NPI:1932178316
Name:BERNARDON, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:BERNARDON
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 1:8020 LIBERTY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2519
Mailing Address - Country:US
Mailing Address - Phone:513-777-8300
Mailing Address - Fax:513-777-2023
Practice Address - Street 1:8020 LIBERTY WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2519
Practice Address - Country:US
Practice Address - Phone:513-777-8300
Practice Address - Fax:513-777-2023
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2262797Medicaid
OH2262797Medicaid
OHH42588Medicare UPIN
OH4055842Medicare PIN