Individual
DR. GORDON R BLEIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
955 S BAILEY AVE, SOUTH HAVEN, MI 49090-9701
(269) 639-2910
(269) 639-2919
Mailing address
955 S BAILEY AVE, SOUTH HAVEN, MI 49090-9701
(269) 639-2910
(269) 639-2919
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
056047
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131167
PHP/IBA
MI
01
—
080064237
RR MEDICARE
MI
01
—
080H06004
BCBSM
MI
05
—
2937733
—
MI
01
—
5976083
AETNA
MI
01
—
P77691
BCN
MI
Enumeration date
08/31/2006
Last updated
11/22/2016
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