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General NPI Number Information
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NPI Number | 1679695977
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Entity Type | Individual
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Provider Name | MICHAEL LYN BERNSTEIN M.D., PHD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 1008 S SPRING AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2520
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Country | US
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Telephone | 314-577-8793
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Fax | 314-268-5062
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Provider Business Mailing Address
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Address Line | 1008 S SPRING AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2520
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Country | US
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Telephone | 314-977-4722
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Fax | 314-977-1877
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 2009009423
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License Number State | MO
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