Healthcare Provider Details

I. General information

NPI: 1154332377
Provider Name (Legal Business Name): MICHAEL J BARNUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ADVENTHEALTH WATERMAN 1000 WATERMAN WAY
TAVARES FL
32778
US

IV. Provider business mailing address

PO BOX 21991
BELFAST ME
04915-4116
US

V. Phone/Fax

Practice location:
  • Phone: 352-742-3578
  • Fax: 352-742-3581
Mailing address:
  • Phone: 352-253-3251
  • Fax: 352-253-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0420011642
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME144090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: