Provider Demographics
NPI:1184656241
Name:BARTHOLOMEW, RICHARD S (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1176
Mailing Address - Country:US
Mailing Address - Phone:248-673-0500
Mailing Address - Fax:248-673-6077
Practice Address - Street 1:4800 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1176
Practice Address - Country:US
Practice Address - Phone:248-673-0500
Practice Address - Fax:248-673-6077
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB012400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114513784Medicaid
MIRB012400OtherSTATE LIC.
MIG91289Medicare UPIN
MI0M7853001Medicare PIN