Healthcare Provider Details

I. General information

NPI: 1891758553
Provider Name (Legal Business Name): ERIC BRIAN BARTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 SUNWOOD DR NW
RAMSEY MN
55303-5190
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-0000
  • Fax: 763-236-0025
Mailing address:
  • Phone: 612-262-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36463
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: