MEDICARE: DR. JAMES TEGART BISHOP 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	207YX0602X	Otolaryngic Allergy Physician	4301033824	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
2	0407054001	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1922001791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES TEGART BISHOP M.D.

Provider Business Mailing Address
First Line	:	388 GARDEN AVE
Second Line	:	STE 100
City	:	HOLLAND
State	:	MI
Zip	:	49424-8998
Country	:	US
Telephone Number	:	616-393-0567
Fax Number	:	616-393-0562

Provider Business Practice Location Address
First Line	:	388 GARDEN AVE
Second Line	:	STE 100
City	:	HOLLAND
State	:	MI
Zip	:	49424-7186
Country	:	US
Telephone Number	:	616-393-0567
Fax Number	:	616-393-0562

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/15/2012

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