Provider Demographics
NPI:1679625891
Name:BARTOS, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:BARTOS
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 1:19270 SONOMA HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:94576
Mailing Address - Country:US
Mailing Address - Phone:707-939-6070
Mailing Address - Fax:707-939-6077
Practice Address - Street 1:19270 SONOMA HIGHWAY
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:94576
Practice Address - Country:US
Practice Address - Phone:707-939-6070
Practice Address - Fax:707-939-6077
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG393682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G393680Medicaid
00G393680Medicare PIN
222746862Medicare UPIN
C60222Medicare UPIN