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General NPI Number Information
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NPI Number | 1649213554
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Entity Type | Individual
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Provider Name | MICHAEL M BERMUDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 3630 WILLOWCREEK RD
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City | PORTAGE
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State | IN
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Zip | 46368-5075
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Country | US
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Telephone | 219-364-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 149 RAINBOW DRIVE #4918
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City | LIVINGSTON
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State | TX
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Zip | 77399-1049
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Country | US
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Telephone | 316-841-4324
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01061935A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 36266
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 208568
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0101241235
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License Number State | VA
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