Healthcare Provider Details

I. General information

NPI: 1831280569
Provider Name (Legal Business Name): RUDY A BARBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N BARLOW RD
HARRISVILLE MI
48740-9607
US

IV. Provider business mailing address

2120 WYNDHAM LN
ALPENA MI
49707-7956
US

V. Phone/Fax

Practice location:
  • Phone: 989-736-8157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301077167
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: