MEDICARE: MR. BLAKE A BERGEON MD

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	208100000X	Physical Medicine & Rehabilitation Physician	4301061418	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619953106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BLAKE A BERGEON MD

Provider Business Mailing Address
First Line	:	555 W WACKERLY ST
Second Line	:	#3825
City	:	MIDLAND
State	:	MI
Zip	:	48640-4710
Country	:	US
Telephone Number	:	989-631-9267
Fax Number	:	989-839-0629

Provider Business Practice Location Address
First Line	:	555 W WACKERLY ST
Second Line	:	#3825
City	:	MIDLAND
State	:	MI
Zip	:	48640-4710
Country	:	US
Telephone Number	:	989-631-9267
Fax Number	:	989-839-0629

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	07/08/2007

Similar Medicare Providers

1417381070 — MIDLAND CHIROPRACTIC
Practice Location Address:

4710 EASTMAN AVE
MIDLAND, MI
48640-2606

Practice Phone: 772-359-8108
Practice Fax:

1225036031 — SURENDRA KAUL M.D.
Practice Location Address:

555 W WACKERLY ST , SUITE 3625
MIDLAND, MI
48640-4710

Practice Phone: 989-835-8625
Practice Fax: 989-839-8864

1659373629 — DR. DAVID T. BORTEL M.D.
Practice Location Address:

555 W WACKERLY ST , SUITE 2600
MIDLAND, MI
48640-4710

Practice Phone: 989-631-0512
Practice Fax: 989-631-7337

1932190725 — JOHN C ECKHOLD JR. M.D.
Practice Location Address:

555 W WACKERLY ST , SUITE 2600
MIDLAND, MI
48640-4710

Practice Phone: 989-839-8824
Practice Fax:

1770563793 — MRS. LESLIE K SCHUTZ MD
Practice Location Address:

555 W WACKERLY ST , #3825
MIDLAND, MI
48640-4710

Practice Phone: 989-631-9267
Practice Fax: 989-839-0629

1003887555 — JOSEPH M IRMEN DDS
Practice Location Address:

4710 N SAGINAW RD
MIDLAND, MI
48640-2310

Practice Phone: 989-631-0840
Practice Fax: 989-631-5350

Directions to “ MR. BLAKE A BERGEON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.