Provider Demographics
NPI:1922001791
Name:BISHOP, JAMES TEGART (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TEGART
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:388 GARDEN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8998
Mailing Address - Country:US
Mailing Address - Phone:616-393-0567
Mailing Address - Fax:616-393-0562
Practice Address - Street 1:388 GARDEN AVE
Practice Address - Street 2:STE 100
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7186
Practice Address - Country:US
Practice Address - Phone:616-393-0567
Practice Address - Fax:616-393-0562
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301033824207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2779821Medicaid
MI0407054001OtherBCBS
MI0407054001OtherBCBS
MI2779821Medicaid