MEDICARE: JEREMY MICHAEL BARTEL M.S., CCC-A, CNIM

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	231H00000X	Audiologist	AU2179	CA

General Provider Information

NPI Number	:	1568490142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY MICHAEL BARTEL M.S., CCC-A, CNIM

Provider Business Mailing Address
First Line	:	3420 ROCKHAMPTON DR
Second Line	:
City	:	SANTA ROSA VALLEY
State	:	CA
Zip	:	93012-7735
Country	:	US
Telephone Number	:	805-558-2446
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 ROCKHAMPTON DR
Second Line	:
City	:	SANTA ROSA VALLEY
State	:	CA
Zip	:	93012-7735
Country	:	US
Telephone Number	:	805-558-2446
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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