Provider Demographics
NPI:1023182037
Name:BORTMAN, JARED SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:SETH
Last Name:BORTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 WEST MAPLE
Mailing Address - Street 2:SUITE 200 GASTROINTESTINAL SPECIALISTS PC
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5435
Mailing Address - Country:US
Mailing Address - Phone:248-273-9930
Mailing Address - Fax:
Practice Address - Street 1:264 W MAPLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5458
Practice Address - Country:US
Practice Address - Phone:248-273-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096120207R00000X
WAML20008789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M10030Medicare PIN