MEDICARE: JOHN J BARTOLOZZI JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	21462	OK

General Provider Information

NPI Number	:	1366445876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J BARTOLOZZI JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 946
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73702-0946
Country	:	US
Telephone Number	:	580-242-5800
Fax Number	:	580-242-5881

Provider Business Practice Location Address
First Line	:	2411 HERITAGE TRL STE 10
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-1652
Country	:	US
Telephone Number	:	580-242-5800
Fax Number	:	580-242-5881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	10/08/2013

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