Healthcare Provider Details

I. General information

NPI: 1700946928
Provider Name (Legal Business Name): VIKTORIYA BARG DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32910 W 13 MILE RD STE. C300
FARMINGTON HILLS MI
48334-1980
US

IV. Provider business mailing address

32910 W 13 MILE RD SUITE C300
FARMINGTON HILLS MI
48334-1980
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 TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002190
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002190
License Number StateMI

VIII. Authorized Official

Name: DR. VIKTORIYA BARG
Title or Position: OWNER AND PHYSICIAN
Credential: DPM
Phone: 248-996-1020