MEDICARE: CHARLES B BARNIV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME43565	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46152	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1932309937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES B BARNIV M.D.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2FLOOR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 HARBOR BLVD STE 3
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2436
Country	:	US
Telephone Number	:	850-837-5181
Fax Number	:	850-654-1947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	08/18/2020

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