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General NPI Number Information
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NPI Number | 1932682044
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Entity Type | Organization
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Legal Business Name | DAVID BARNEY PLLC
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 6690 CROSSINGS DR SE STE C
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-7394
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Country | US
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Telephone | 616-600-1885
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Fax |
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Provider Business Mailing Address
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Address Line | 6690 CROSSINGS DR SE STE C
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-7394
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | CHARLES J ZICKUS
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Credential | DO
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Telephone | 616-443-5806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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