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NPI Code Detail

MEDICARE: DR. BRUCE J BARTIE D.O.

MEDICARE: DR. BRUCE J BARTIE D.O.
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
1207XS0117XOrthopaedic Surgery of the Spine Physician48779WI
2207XS0117XOrthopaedic Surgery of the Spine Physician29692MN

General Provider Information

NPI Number : 1942206610
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE J BARTIE D.O.
Provider Business Mailing Address
First Line : 5803 NEAL AVE N
Second Line :
City : OAK PARK HEIGHTS
State : MN
Zip : 55082-2177
Country : US
Telephone Number : 651-439-8807
Fax Number : 651-439-0232
Provider Business Practice Location Address
First Line : 5803 NEAL AVE N
Second Line :
City : OAK PARK HEIGHTS
State : MN
Zip : 55082-2177
Country : US
Telephone Number : 651-439-8807
Fax Number : 651-439-0232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 06/30/2015

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