1578534699 NPI number — DR. CASEY R BARTMAN MD

Table of content: DR. CASEY R BARTMAN MD (NPI 1578534699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578534699 NPI number — DR. CASEY R BARTMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTMAN
Provider First Name:
CASEY
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578534699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49083-0250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-844-8188
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9363 E D AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49083-9497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
629-269-5090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  CB047651 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101730719 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04113561 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: CB047651 . This is a "STATE OF MICHIGAN LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com