Healthcare Provider Details

I. General information

NPI: 1427755529
Provider Name (Legal Business Name): TYLER BARNES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48801 ROMEO PLANK RD STE 103
MACOMB MI
48044-2165
US

IV. Provider business mailing address

43455 SCHOENHERR RD STE 2
STERLING HEIGHTS MI
48313-1972
US

V. Phone/Fax

Practice location:
  • Phone: 586-726-4823
  • Fax: 586-726-8365
Mailing address:
  • Phone: 586-726-4823
  • Fax: 586-726-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: