Healthcare Provider Details

I. General information

NPI: 1114139391
Provider Name (Legal Business Name): JAMES RUSSELL BARNA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 FOREST ST
RIVER ROUGE MI
48218-1534
US

IV. Provider business mailing address

PO BOX 998
ALLEN PARK MI
48101-0998
US

V. Phone/Fax

Practice location:
  • Phone: 734-397-7000
  • Fax: 313-388-9264
Mailing address:
  • Phone: 248-581-4437
  • Fax: 313-636-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001577
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: