Healthcare Provider Details

I. General information

NPI: 1164402277
Provider Name (Legal Business Name): VIKTORIYA BARG DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32910 WEST 13 MILE RD SUITE C300
FARMINGTON HILLS MI
48334-1983
US

IV. Provider business mailing address

32910 WEST 13 MILE RD SUITE C300
FARMINGTON HILLS MI
48334-1983
US

V. Phone/Fax

Practice location:
  • Phone: 248-996-1020
  • Fax: 248-996-1023
Mailing address:
  • Phone: 248-996-1020
  • Fax: 248-996-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002190
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: