Provider Demographics
NPI:1528001484
Name:BARTKUS, EDWARD A II (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:BARTKUS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 SENATE BLVD
Practice Address - Street 2:EMERGENCY MEDICINE & TRAUMA CENTER
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-8880
Practice Address - Fax:317-962-7086
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1045274207P00000X
IN01045274A207PE0004X, 207P00000X
IN01045274207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400034982OtherMEDICARE PTAN
IN930107730OtherRR MEDICARE
IN200109710Medicaid
INP00903547OtherRAILROAD MEDICARE PTAN
IN264430SSSOtherMEDICARE PTAN