Healthcare Provider Details

I. General information

NPI: 1780091546
Provider Name (Legal Business Name): ANGEL BERMUDEZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 COLONY DR N
SAGINAW MI
48638-7157
US

IV. Provider business mailing address

PO BOX 779
TAWAS CITY MI
48764-0779
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-1350
  • Fax: 989-799-6833
Mailing address:
  • Phone: 989-799-1350
  • Fax: 989-799-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4301500204
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: