Provider Demographics
NPI:1962472423
Name:BIEDERMAN, MICHAEL A (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:BIEDERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 203901
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:248-471-8982
Mailing Address - Fax:248-471-9978
Practice Address - Street 1:23133 ORCHARD LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3268
Practice Address - Country:US
Practice Address - Phone:248-579-9220
Practice Address - Fax:248-471-9978
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006198207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2880078-11Medicaid
MI0F37118Medicare PIN
B43586Medicare UPIN