Provider Demographics
NPI:1811167216
Name:BERMEO, MIGUEL ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ENRIQUE
Last Name:BERMEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:49085-9159
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:49085-9159
Practice Address - Country:US
Practice Address - Phone:269-429-8010
Practice Address - Fax:269-408-0986
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01064891207V00000X
WAMD60066926207V00000X
MI4301104199207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology