MEDICARE: DR. MICHAEL F. BARDWIL 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	2086S0129X	Vascular Surgery Physician	G3131	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8C0060	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689672594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL F. BARDWIL M.D.

Provider Business Mailing Address
First Line	:	13254 FORKLAND DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077
Country	:	US
Telephone Number	:	713-461-4945
Fax Number	:	713-461-7677

Provider Business Practice Location Address
First Line	:	13254 FORKLAND DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-2301
Country	:	US
Telephone Number	:	713-461-4945
Fax Number	:	713-461-7677

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	11/18/2011

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