Basic Information
| Provider Information | |||||||||
| NPI: | 1659437572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5607 NW 27TH AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331422826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058051700 | ||||||||
| FaxNumber: | 3058051715 | ||||||||
| Practice Location | |||||||||
| Address1: | 5361 NW 22ND AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331428035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056376400 | ||||||||
| FaxNumber: | 3056365155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 54014 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | ME129274 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | ME129274 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 019618200 | 05 | FL | MEDICAID |