Provider Demographics
NPI:1326001223
Name:BARGWELL, STEVEN T (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:T
Last Name:BARGWELL
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 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:MEDICAL ADMINISTRATION
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-6320
Mailing Address - Fax:616-252-6360
Practice Address - Street 1:14211 WHITE CREEK AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8168
Practice Address - Country:US
Practice Address - Phone:616-696-6320
Practice Address - Fax:616-696-6360
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326001223Medicaid
MIM53750057Medicare PIN
MI1326001223Medicaid
MI08-5-41-0288-5OtherBCBS PIN