Provider Demographics
NPI:1013987445
Name:BERNO, MICHAEL G (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:BERNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:G
Other - Last Name:BERNO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 66308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6308
Mailing Address - Country:US
Mailing Address - Phone:832-548-5275
Mailing Address - Fax:
Practice Address - Street 1:6730 INDEPENDENCE BLVD
Practice Address - Street 2:#300
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:713-351-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK35562084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10009096OtherAMERIGROUP
TX080462703Medicaid
TX143877205Medicaid
TX82867GOtherBLUE CROSS BLUE SHIELD
TX82867GOtherBLUE CROSS BLUE SHIELD
TX143877205Medicaid