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General NPI Number Information
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NPI Number | 1255548434
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Entity Type | Organization
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Legal Business Name | BARRY BEAN DPM PLLC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 21721 W 11 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3717
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Country | US
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Telephone | 248-355-4888
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Fax | 248-355-2565
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Provider Business Mailing Address
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Address Line | 21721 W 11 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3717
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Country | US
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Telephone | 248-355-4888
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Fax | 248-355-2565
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Authorized Official
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Title or Position | PHYSICIAN
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Name | BARRY BEAN
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Credential | DPM
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Telephone | 248-355-4888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | BB000712
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License Number State | MI
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