Provider Demographics
NPI:1043845928
Name:BARTOSEK, KOLLEEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KOLLEEN
Middle Name:
Last Name:BARTOSEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 W FRONT ST STE C
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2368
Mailing Address - Country:US
Mailing Address - Phone:231-642-5031
Mailing Address - Fax:231-525-2306
Practice Address - Street 1:1225 W FRONT ST STE C
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2368
Practice Address - Country:US
Practice Address - Phone:231-642-5031
Practice Address - Fax:231-525-2306
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant