Healthcare Provider Details

I. General information

NPI: 1366636755
Provider Name (Legal Business Name): LONSON L BARR, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 BOSTON ST SE STE 303
GRAND RAPIDS MI
49506-4100
US

IV. Provider business mailing address

1945 BOSTON ST SE STE 303
GRAND RAPIDS MI
49506-4100
US

V. Phone/Fax

Practice location:
  • Phone: 616-246-6262
  • Fax: 616-246-8737
Mailing address:
  • Phone: 616-246-6262
  • Fax: 616-246-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101005711
License Number StateMI

VIII. Authorized Official

Name: DR. LONSON L BARR
Title or Position: PRESIDENT & PHYSICIAN
Credential: D.O.
Phone: 616-246-6262