Provider Demographics
NPI:1285498162
Name:BISH, MICHAEL B
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:BISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 FOXFIRE TRL
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2548
Mailing Address - Country:US
Mailing Address - Phone:937-776-3832
Mailing Address - Fax:
Practice Address - Street 1:792 FOXFIRE TRL
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2548
Practice Address - Country:US
Practice Address - Phone:937-776-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child