Provider Demographics
NPI:1649435835
Name:SURGICAL SPECIALISTS OF BOWLING GREEN LLC
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS OF BOWLING GREEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIELEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-352-9124
Mailing Address - Street 1:960 W WOOSTER ST STE 208
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2650
Mailing Address - Country:US
Mailing Address - Phone:419-352-9124
Mailing Address - Fax:419-353-7334
Practice Address - Street 1:960 W WOOSTER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2644
Practice Address - Country:US
Practice Address - Phone:419-352-9124
Practice Address - Fax:419-353-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066329B208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDO3187OtherRR MEDICARE
OH2860980Medicaid
OHDO3187OtherRR MEDICARE