Healthcare Provider Details

I. General information

NPI: 1861503492
Provider Name (Legal Business Name): BRUCE BIALOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24100 SOUTHFIELD RD SUITE 200
SOUTHFIELD MI
48075-2819
US

IV. Provider business mailing address

24100 SOUTHFIELD RD SUITE 200
SOUTHFIELD MI
48075-2819
US

V. Phone/Fax

Practice location:
  • Phone: 248-559-3400
  • Fax: 248-557-5580
Mailing address:
  • Phone: 248-559-3400
  • Fax: 248-557-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301065347
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: