MEDICARE: MARC A BERNHISEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VE0102X	Reproductive Endocrinology Physician	ME47242	FL
2	207VE0102X	Reproductive Endocrinology Physician	165085-1205	UT
3	207VE0102X	Reproductive Endocrinology Physician	27121	NC

General Provider Information

NPI Number	:	1528053667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC A BERNHISEL M.D.

Provider Business Mailing Address
First Line	:	5245 E FLETCHER AVE
Second Line	:	SUITE 1
City	:	TAMPA
State	:	FL
Zip	:	33617-1126
Country	:	US
Telephone Number	:	813-914-7304
Fax Number	:	813-676-8838

Provider Business Practice Location Address
First Line	:	5245 E FLETCHER AVE
Second Line	:	SUITE 1
City	:	TAMPA
State	:	FL
Zip	:	33617-1126
Country	:	US
Telephone Number	:	813-914-7304
Fax Number	:	813-676-8838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	03/07/2012

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