Healthcare Provider Details

I. General information

NPI: 1447380324
Provider Name (Legal Business Name): CLARENCE RICHARD BARNETT MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 4TH AVE
LAKE ODESSA MI
48849-1004
US

IV. Provider business mailing address

1020 4TH AVE
LAKE ODESSA MI
48849-1004
US

V. Phone/Fax

Practice location:
  • Phone: 616-374-8881
  • Fax: 616-374-4220
Mailing address:
  • Phone: 616-374-8881
  • Fax: 616-374-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCB047150
License Number StateMI

VIII. Authorized Official

Name: CLARENCE RICHARD BARNETT
Title or Position: OWNER
Credential: M.D.
Phone: 616-374-8881