Provider Demographics
NPI:1154358331
Name:BARD, JOHN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:BARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3950 HOLLYWOOD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9151
Mailing Address - Country:US
Mailing Address - Phone:269-429-8010
Mailing Address - Fax:269-408-0986
Practice Address - Street 1:3950 HOLLYWOOD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9151
Practice Address - Country:US
Practice Address - Phone:269-429-8010
Practice Address - Fax:269-408-0986
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MI4301080587207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI07-30373OtherPHP
MI1601103621OtherBLUE CROSS
MI4661553Medicaid
160059263OtherRAILROAD MEDICARE
2351146OtherCIGNA
2351146OtherCIGNA
MI07-30373OtherPHP
MI1601103621OtherBLUE CROSS