Provider Demographics
NPI:1871782136
Name:CASEY R BARTMAN MD PC
Entity type:Organization
Organization Name:CASEY R BARTMAN MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-956-7716
Mailing Address - Street 1:751 KENMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-956-7716
Mailing Address - Fax:616-956-0839
Practice Address - Street 1:751 KENMOOR AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-956-7716
Practice Address - Fax:616-956-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICB047651207X00000X
MI047651207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0411356OtherBLUE CROSS BLUE SHIELD
MI1422OtherPRIORITY HEALTH
MI101730719Medicaid
MI1730719Medicaid
MI2004113561OtherBLUE CROSS
MI2004113561OtherBLUE CARE NETWORK
MI2004113561OtherBLUE CROSS
MI101730719Medicaid
MI0N17710Medicare PIN