Provider Demographics
NPI:1164402277
Name:BARG, VIKTORIYA (DPM)
Entity Type:Individual
Prefix:
First Name:VIKTORIYA
Middle Name:
Last Name:BARG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32910 WEST 13 MILE RD
Mailing Address - Street 2:SUITE C300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1983
Mailing Address - Country:US
Mailing Address - Phone:248-996-1020
Mailing Address - Fax:248-996-1023
Practice Address - Street 1:32910 WEST 13 MILE RD
Practice Address - Street 2:SUITE C300
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1983
Practice Address - Country:US
Practice Address - Phone:248-996-1020
Practice Address - Fax:248-996-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002190213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4997427Medicaid
P40900001Medicare PIN