Healthcare Provider Details

I. General information

NPI: 1356359095
Provider Name (Legal Business Name): TIFFANY L BARTELD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY L MOLINARI PA

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 LUDINGTON STREET SUITE 203
ESCANABA MI
49829
US

IV. Provider business mailing address

3409 LUDINGTON STREET SUITE 203
ESCANABA MI
49829
US

V. Phone/Fax

Practice location:
  • Phone: 906-789-4427
  • Fax: 906-789-4446
Mailing address:
  • Phone: 906-789-4427
  • Fax: 906-789-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004371
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: