MEDICARE: CLARENCE RICHARD BARNETT MD PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	CB047150	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	135	OTHER	MI	PRIORITY HEALTH
2	200000001213	OTHER	MA	PHYSICIANS HEALTH PLAN
3	0340028	OTHER	MI	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447380324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARENCE RICHARD BARNETT MD PLC

Provider Business Mailing Address
First Line	:	1020 4TH AVE
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-1004
Country	:	US
Telephone Number	:	616-374-8881
Fax Number	:	616-374-4220

Provider Business Practice Location Address
First Line	:	1020 4TH AVE
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-1004
Country	:	US
Telephone Number	:	616-374-8881
Fax Number	:	616-374-4220

Authorized Official
Title or Position	:	OWNER
Name	:	CLARENCE RICHARD BARNETT
Credential	:	M.D.
Telephone Number	:	616-374-8881

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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