Provider Demographics
NPI:1073576039
Name:BARLETTA, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:BARLETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5477 W CLARK RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1102
Mailing Address - Country:US
Mailing Address - Phone:734-434-6000
Mailing Address - Fax:734-434-7005
Practice Address - Street 1:5477 W CLARK RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1102
Practice Address - Country:US
Practice Address - Phone:734-434-6000
Practice Address - Fax:734-434-7005
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055842207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3170612Medicaid
MIOH16033-006Medicare ID - Type Unspecified
MIF84377Medicare UPIN