Individual provider Active NPI

Michael J Bernklau, DDS

  • Dentist
  • Milwaukee, WI
National Provider Identifier
1639366297
Registry record updated Sep 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5001731-015 Issued in WI
Practice address
6200 W Bluemound Rd
Milwaukee, WI 53213-4145
Phone
(414) 771-5600
Fax
(414) 476-9988
NPI assigned
Sep 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 5001731-015 WI Primary

Addresses

Primary practice location

6200 W Bluemound Rd
Milwaukee, WI 53213-4145

Mailing address

6200 W Bluemound Rd
Milwaukee, WI 53213-4145
Phone (414) 771-5600

Other identifiers 1

IdentifierTypeStateIssuer
5001731-015OtherWILICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5001731-015WIMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190851200000",
    "number": "1639366297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 W BLUEMOUND RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532134145",
            "telephone_number": "414-771-5600",
            "fax_number": "414-476-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 W BLUEMOUND RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532134145",
            "telephone_number": "414-771-5600",
            "fax_number": "414-476-9988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNKLAU",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-27",
        "last_updated": "2007-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "5001731-015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "5001731-015",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.