Provider Demographics
NPI:1598751703
Name:BARKETT, VANDER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:VANDER
Middle Name:MICHAEL
Last Name:BARKETT
Suffix:
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 1:16150 COUNTY ROAD 220
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9428
Mailing Address - Country:US
Mailing Address - Phone:719-530-2000
Mailing Address - Fax:719-530-2055
Practice Address - Street 1:550 W HWY 50
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2238
Practice Address - Country:US
Practice Address - Phone:719-530-2000
Practice Address - Fax:719-530-2055
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23436208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01234368Medicaid
COCO40625Medicare PIN