MEDICARE: MICHAEL E. LEARMAN D.D.S., P.L.C.

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	122300000X	Dentist	14212	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202055563	OTHER	MI	TAX NUMBER

General Provider Information

NPI Number	:	1700866530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E. LEARMAN D.D.S., P.L.C.

Provider Business Mailing Address
First Line	:	4141 SHRESTHA DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2171
Country	:	US
Telephone Number	:	989-667-5630
Fax Number	:	989-667-5726

Provider Business Practice Location Address
First Line	:	4141 SHRESTHA DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2171
Country	:	US
Telephone Number	:	989-667-5630
Fax Number	:	989-667-5726

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	10/15/2020

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