Provider Demographics
NPI:1205898822
Name:BARTHELL, EDWARD N (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:N
Last Name:BARTHELL
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 1:125 E BARKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5893
Mailing Address - Country:US
Mailing Address - Phone:414-290-6720
Mailing Address - Fax:414-290-6755
Practice Address - Street 1:125 E BARKWOOD CT
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5893
Practice Address - Country:US
Practice Address - Phone:414-290-6720
Practice Address - Fax:414-290-6755
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095360207P00000X
WI26092207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30700200Medicaid
WI110136770OtherMEDICARE RAILROAD
WIP00024343OtherMEDICARE RAILROAD
WI930085038OtherMEDICARE RAILROAD
WI002071116Medicare ID - Type Unspecified
WI002632280Medicare ID - Type Unspecified
WI002010006Medicare ID - Type Unspecified
WI002468655Medicare ID - Type Unspecified
WI30700200Medicaid
WI000807660Medicare ID - Type Unspecified
B51386Medicare UPIN
WI001532250Medicare ID - Type Unspecified
WI000560045Medicare ID - Type Unspecified
WI002401400Medicare ID - Type Unspecified
WI110136770OtherMEDICARE RAILROAD