Healthcare Provider Details

I. General information

NPI: 1558320846
Provider Name (Legal Business Name): CLARENCE RICHARD BARNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/09/2007
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

650 LAKEVIEW DR
LAKE ODESSA MI
48849-1274
US

V. Phone/Fax

Practice location:
  • Phone: 616-374-8881
  • Fax: 616-374-4220
Mailing address:
  • Phone: 616-374-8259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301047150
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: