MEDICARE: HAROLD LEE BACHELDOR JR. DO

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	207Q00000X	Family Medicine Physician	5101009734	MI

General Provider Information

NPI Number	:	1831186550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAROLD LEE BACHELDOR JR. DO

Provider Business Mailing Address
First Line	:	4014 RIVER RD
Second Line	:	BUILDING 6
City	:	EAST CHINA
State	:	MI
Zip	:	48054-2916
Country	:	US
Telephone Number	:	810-329-6677
Fax Number	:	810-329-7780

Provider Business Practice Location Address
First Line	:	4014 RIVER RD
Second Line	:	BUILDING 6
City	:	EAST CHINA
State	:	MI
Zip	:	48054-2916
Country	:	US
Telephone Number	:	810-329-6677
Fax Number	:	810-329-7780

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/22/2015

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