=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063775484
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE ELIZABETH BARRETT M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2012
-----------------------------------------------------
Last Update Date | 09/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 W UNIVERSITY DR FL 2
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48307-1863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-652-5331
-----------------------------------------------------
Fax | 248-652-5748
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 YORK ST DEPT OF NEONATAL-PERINATAL MEDICINE
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06510-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-598-4971
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 054368
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 4301510167
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------