Healthcare Provider Details

I. General information

NPI: 1285629238
Provider Name (Legal Business Name): JILL M BARRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 S MARTIN LUTHER KING JR BLVD
LANSING MI
48910-2695
US

IV. Provider business mailing address

PO BOX 746723
ATLANTA GA
30374-6723
US

V. Phone/Fax

Practice location:
  • Phone: 517-253-1304
  • Fax:
Mailing address:
  • Phone: 313-723-6000
  • Fax: 313-424-4058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35061601
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301507790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: