Individual
MR. BLAKE A BERGEON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 W WACKERLY ST, #3825, MIDLAND, MI 48640-4710
(989) 631-9267
(989) 839-0629
Mailing address
555 W WACKERLY ST, #3825, MIDLAND, MI 48640-4710
(989) 631-9267
(989) 839-0629
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301061418
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3383068
—
MI
Enumeration date
12/16/2005
Last updated
07/08/2007
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