Healthcare Provider Details

I. General information

NPI: 1952278459
Provider Name (Legal Business Name): MICHAEL KARL BJELLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 SHELBURNE RD STE D2 PIERSON HOUSE D2
SOUTH BURLINGTON VT
05403-7753
US

IV. Provider business mailing address

1233 SHELBURNE RD STE D2 PIERSON HOUSE D2
SOUTH BURLINGTON VT
05403-7753
US

V. Phone/Fax

Practice location:
  • Phone: 802-859-1577
  • Fax:
Mailing address:
  • Phone: 802-859-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number097.0136505
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: