Provider Demographics
NPI:1700946928
Name:VIKTORIYA BARG DPM PC
Entity type:Organization
Organization Name:VIKTORIYA BARG DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKTORIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-996-1020
Mailing Address - Street 1:32910 W 13 MILE RD
Mailing Address - Street 2:SUITE C300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1980
Mailing Address - Country:US
Mailing Address - Phone:248-996-1020
Mailing Address - Fax:248-996-1023
Practice Address - Street 1:32910 W 13 MILE RD
Practice Address - Street 2:STE. C300
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1980
Practice Address - Country:US
Practice Address - Phone:248-996-1020
Practice Address - Fax:248-996-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002190213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4997427Medicaid
MI4855012210OtherBLUECROSS BLUESHIELD NUMB
MI1164402277Medicaid
0P40900Medicare PIN