MEDICARE: BERNARD DEGNAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0205X	Pediatric Endocrinology Physician	4301069431	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144214990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARD DEGNAN MD

Provider Business Mailing Address
First Line	:	22201 MOROSS RD
Second Line	:	SUITE 270
City	:	DETROIT
State	:	MI
Zip	:	48236-2169
Country	:	US
Telephone Number	:	313-343-3809
Fax Number	:	313-417-0560

Provider Business Practice Location Address
First Line	:	3535 W 13 MILE RD # 707
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6770
Country	:	US
Telephone Number	:	248-551-0487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	10/21/2020

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Directions to “ BERNARD DEGNAN MD” Practice Location

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