MEDICARE: JONATHAN M BERNSTEIN M.D.

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	207W00000X	Ophthalmology Physician	4301061141	MI
2	207W00000X	Ophthalmology Physician	64990	OH
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	4301061141	MI
4	207WX0107X	Retina Specialist (Ophthalmology) Physician	64990	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180018195	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000126978	OTHER	OH	ANTHEM BCBS

General Provider Information

NPI Number	:	1497750574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN M BERNSTEIN M.D.

Provider Business Mailing Address
First Line	:	850 W NORTH ST STE 104
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-3196
Country	:	US
Telephone Number	:	877-852-8463
Fax Number	:	517-817-0144

Provider Business Practice Location Address
First Line	:	3000 REGENCY CT STE 100
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3081
Country	:	US
Telephone Number	:	800-832-2015
Fax Number	:	419-885-8440

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/21/2022

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Directions to “ JONATHAN M BERNSTEIN M.D.” Practice Location

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