Provider Demographics
NPI:1407150683
Name:WILLIAM BARTELS, M.D., INC.
Entity type:Organization
Organization Name:WILLIAM BARTELS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARTELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-533-9515
Mailing Address - Street 1:459 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1424
Mailing Address - Country:US
Mailing Address - Phone:330-533-9515
Mailing Address - Fax:330-533-9619
Practice Address - Street 1:459 LISBON ST
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1424
Practice Address - Country:US
Practice Address - Phone:330-533-9515
Practice Address - Fax:330-533-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-3289208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0908254Medicaid
OH0908254Medicaid
BA0732662Medicare PIN