MEDICARE: DR. CLARENCE RICHARD BARNETT M.D.

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	4301047150	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0130191	OTHER	MI	PHP KALAMAZOO PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0340028	OTHER	MI	BCBS
5	0100558	OTHER	MI	PHP LANSING PLAN

General Provider Information

NPI Number	:	1558320846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARENCE RICHARD BARNETT M.D.

Provider Business Mailing Address
First Line	:	650 LAKEVIEW DR
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-1274
Country	:	US
Telephone Number	:	616-374-8259
Fax Number	:

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/09/2007

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