Provider Demographics
NPI:1265177794
Name:BARTHELS, TAYLOR RICHARD
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RICHARD
Last Name:BARTHELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 GRAND CASTLE BLVD SW APT E846
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1786
Mailing Address - Country:US
Mailing Address - Phone:636-980-7695
Mailing Address - Fax:
Practice Address - Street 1:1675 LEAHY ST STE 201
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5542
Practice Address - Country:US
Practice Address - Phone:231-672-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program