Provider Demographics
NPI:1528254935
Name:HUMBERTO BERNAL MD PC
Entity type:Organization
Organization Name:HUMBERTO BERNAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:BERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-336-7400
Mailing Address - Street 1:18100 OAKWOOD BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4085
Mailing Address - Country:US
Mailing Address - Phone:313-336-7400
Mailing Address - Fax:313-336-6709
Practice Address - Street 1:18100 OAKWOOD BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4085
Practice Address - Country:US
Practice Address - Phone:313-336-7400
Practice Address - Fax:313-336-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044715207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1608226311OtherBCBS
MI3515265Medicaid
MI=========OtherCOMMERCIALS
MI1608226311OtherBCBS
MIB47449Medicare UPIN