Provider Demographics
NPI:1104202787
Name:GOMMESEN, BARTHOLOMEW
Entity Type:Individual
Prefix:
First Name:BARTHOLOMEW
Middle Name:
Last Name:GOMMESEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6796 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:HOWARD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329-9502
Mailing Address - Country:US
Mailing Address - Phone:231-937-9377
Mailing Address - Fax:
Practice Address - Street 1:6796 BAILEY RD
Practice Address - Street 2:
Practice Address - City:HOWARD CITY
Practice Address - State:MI
Practice Address - Zip Code:49329-9502
Practice Address - Country:US
Practice Address - Phone:231-937-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator