Provider Demographics
NPI:1831186550
Name:BACHELDOR, HAROLD LEE JR (DO)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:LEE
Last Name:BACHELDOR
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:H.
Other - Middle Name:LEE
Other - Last Name:BACHELDOR
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4014 RIVER RD
Mailing Address - Street 2:BUILDING 6
Mailing Address - City:EAST CHINA
Mailing Address - State:MI
Mailing Address - Zip Code:48054-2916
Mailing Address - Country:US
Mailing Address - Phone:810-329-6677
Mailing Address - Fax:810-329-7780
Practice Address - Street 1:4014 RIVER RD
Practice Address - Street 2:BUILDING 6
Practice Address - City:EAST CHINA
Practice Address - State:MI
Practice Address - Zip Code:48054-2916
Practice Address - Country:US
Practice Address - Phone:810-329-6677
Practice Address - Fax:810-329-7780
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN71040001Medicare PIN
E33240Medicare UPIN
MI4506547Medicaid