Provider Demographics
NPI:1932210721
Name:BARTELL, MISTI MICHELLE (DO)
Entity Type:Individual
Prefix:MRS
First Name:MISTI
Middle Name:MICHELLE
Last Name:BARTELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15255 N 40TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4624
Mailing Address - Country:US
Mailing Address - Phone:602-867-2690
Mailing Address - Fax:602-404-1904
Practice Address - Street 1:15255 N 40TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4624
Practice Address - Country:US
Practice Address - Phone:602-867-2690
Practice Address - Fax:602-404-1904
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3922207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ793142Medicaid
AZ793142Medicaid
76821Medicare ID - Type Unspecified