Michael D Bork, DO
Individual provider Active NPI Maternal & Fetal Medicine Physician · Wyandotte, MI
NPI 1659342152 · NPPES record last updated Feb 21, 2017
Key facts
- NPI
- 1659342152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Maternal & Fetal Medicine Physician 207VM0101X
- License
- 5101010520 (MI)
- Practice address
- 2333 Biddle Ave
Wyandotte, MI 48192-4668 - Phone
- (734) 246-8895
- Fax
- (734) 324-3404
- NPI assigned
- Feb 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 12
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Physicians for Women'S Health, LLC
Practice addresses (Care Compare)
103 Newtown Rd
Candlewood Center for Womens Health
Danbury, CT 06810-4195
Phone (203) 730-8789
4 Corporate Dr
Suite 484
Shelton, CT 06484-6241
Phone (203) 944-9898
4 Shaws CV
New London, CT 06320-4956
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI, CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051003000046 | MI | Practitioner - Obstetrics/Gynecology | 4284669813 | Reassigns benefits to 3 organizations |
| I20260414000526 | CT | Practitioner - Obstetrics/Gynecology | 4284669813 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101010520 | MI | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hurley Medical Center | Current |
Accepting new patients | |
| Henry Ford Wyandotte Hospital | Current |
Accepting new patients | |
| Bronson Methodist Hospital | Obstetrics & Gynecology | Current |
Accepting new patients |
| Hurley Medical Center | Current |
Accepting new patients | |
| Hurley Medical Center | Obstetrics & Gynecology | Current | Accepting new patients |
| Henry Ford Wyandotte Hospital | Obstetrics & Gynecology | Current | Accepting new patients |
| Henry Ford Wyandotte Hospital | Current |
Accepting new patients | |
| Hurley Medical Center | Past | Accepting new patients | |
| Oakwood Group VIII LLC | Past | Accepting new patients | |
| Henry Ford Wyandotte Hospital | Past | Accepting new patients | |
| Michigan Perinatal Associates PC | Maternal & Fetal Medicine | Past |
Accepting new patients |
Locations
1 Hurley Plz
#3D
Flint, MI 48503
Phone (810) 262-6046
1 Hurley Plz
Flint, MI 48503
Phone (810) 257-9000
601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500
1640 Fort St
Ste D
Trenton, MI 48183
Phone (734) 391-3057
2333 Biddle Ave
Wyandotte, MI 48192
Phone (734) 246-6000
2070 Biddle Ave
Ste 2
Wyandotte, MI 48192
Phone (734) 284-7482
Interoperability endpoints
- mbork59836@direct.hfhs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 5101010520 | MI | |
| Maternal & Fetal Medicine Physician | 207VM0101X | 5101010520 | MI | Yes |
Addresses
Primary practice location
2333 Biddle Ave
Wyandotte, MI 48192-4668
Mailing address
1640 Fort Street
Suite D Attn Denise
Trenton, MI 48183
Phone (734) 391-3057
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 382791823 | Other | MI | TAX ID |
| 0H24657 | Other | MI | BLUE CROSS |
| F67493 | Other | MI | UPIN |
Other providers in Wyandotte, MI
- Hannah Marie Bolsley
- Bridget Antonia Bonello
- Joyce A Bonventre
- Micah Noel Boone
- Austin Henry Boots
- Lisa Marie Boucher
- Jimmy Roger Boutin
- Crystal Bowen
- Alexe Bowlby
- Haroutioun Boyajian
All providers in Wyandotte, MI · Maternal & Fetal Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.