Healthcare Provider Details

I. General information

NPI: 1073576039
Provider Name (Legal Business Name): JOHN P BARLETTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 CHARLEVOIX RD
BAY HARBOR MI
49770-9815
US

IV. Provider business mailing address

4070 CHARLEVOIX RD
BAY HARBOR MI
49770-9815
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-5315
  • Fax: 231-487-5316
Mailing address:
  • Phone: 231-487-5315
  • Fax: 231-487-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301055842
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: