MEDICARE: MICHAEL SCOTT MERSOL-BARG 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	207VE0102X	Reproductive Endocrinology Physician	4301056302	MI
2	207V00000X	Obstetrics & Gynecology Physician	4301056302	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1606332721	OTHER	MI	BLUE CROSS BLUE SHIELD MI

General Provider Information

NPI Number	:	1275545634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SCOTT MERSOL-BARG MD

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	41000 WOODWARD AVE
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5130
Country	:	US
Telephone Number	:	248-593-6990
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	09/15/2025

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