Provider Demographics
NPI:1972481265
Name:SMITH, BERGALOWSKI ANTONIO
Entity type:Individual
Prefix:
First Name:BERGALOWSKI
Middle Name:ANTONIO
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 BRENT AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-3920
Mailing Address - Country:US
Mailing Address - Phone:810-308-6310
Mailing Address - Fax:
Practice Address - Street 1:3405 BRENT AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-3920
Practice Address - Country:US
Practice Address - Phone:810-308-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker