Healthcare Provider Details

I. General information

NPI: 1598818536
Provider Name (Legal Business Name): DOMINIC V BARBERIO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W SAGINAW ST 2ND FLOOR
LANSING MI
48915-1927
US

IV. Provider business mailing address

8175 RELIABLE PKWY
CHICAGO IL
60686-0081
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-7700
  • Fax: 517-364-7701
Mailing address:
  • Phone: 517-364-6253
  • Fax: 517-364-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number5101010428
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101010428
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: