Healthcare Provider Details

I. General information

NPI: 1750794988
Provider Name (Legal Business Name): ROSS CHRISTOPHER BARTLEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 E 12 MILE RD STE 102
WARREN MI
48093-3487
US

IV. Provider business mailing address

11900 E 12 MILE RD STE 102
WARREN MI
48093-3487
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-7470
  • Fax: 586-573-0850
Mailing address:
  • Phone: 586-573-7470
  • Fax: 586-573-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: