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General NPI Number Information
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NPI Number | 1801033816
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Entity Type | Organization
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Legal Business Name | CP BARTLEY INC
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 7007 W JOHNSON RD
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-2928
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Country | US
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Telephone | 219-256-1579
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Fax |
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Provider Business Mailing Address
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Address Line | 13547 VENTURA BLVD SUITE 92
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-3825
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Country | US
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Telephone | 219-256-1579
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHARLES P BARTLEY
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Credential |
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Telephone | 219-256-1579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01052194A
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License Number State | IN
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