Provider Demographics
NPI:1861619736
Name:BARTKIW, MYKOLA JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:MYKOLA
Middle Name:JOHN
Last Name:BARTKIW
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3100 CROSS CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2774
Mailing Address - Country:US
Mailing Address - Phone:248-377-8000
Mailing Address - Fax:248-377-2929
Practice Address - Street 1:3100 CROSS CREEK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2774
Practice Address - Country:US
Practice Address - Phone:248-377-8000
Practice Address - Fax:248-377-2929
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016552207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1861619736Medicaid
MI1861619736Medicaid