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General NPI Number Information
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NPI Number | 1801001771
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Entity Type | Individual
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Provider Name | SERGIO BARTAKIAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | CHILDREN'S HOSPITAL OF MI - 4TH 3901 BEAUBIEN
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-745-5481
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Fax | 313-966-2423
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Provider Business Mailing Address
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Address Line | UNIVERSITY PEDIATRICIANS 4201 ST. ANTOINE UHC 5D # 226
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-966-5051
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Fax | 313-966-0665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | A121219
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 47596
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 57.011456
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301119342
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | P7881
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 4301119342
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License Number State | MI
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