Provider Demographics
NPI:1457335994
Name:DEMAERSCHALK, BART M (MD)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:M
Last Name:DEMAERSCHALK
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 1:5777 E MAYO BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4502
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:5777 E MAYO BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK338262084N0400X
NV150842084N0400X
NH163432084N0400X
IA434642084N0400X
VT042.00129012084N0400X
MO20160269702084N0400X
MN600402084N0400X
MEMD202042084N0400X
WI656912084N0400X
FLME1272312084N0400X
GA0757782084N0400X
AZ290472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ592809Medicaid
AZ86080015085259A866OtherTRIWEST
H47062Medicare UPIN
AZ86080015085259A866OtherTRIWEST
AZZ66427Medicare PIN