Provider Demographics
NPI:1073726329
Name:BARNOSKY, BRYAN G (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:G
Last Name:BARNOSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50505 SCHOENHERR RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3140
Mailing Address - Country:US
Mailing Address - Phone:586-314-0080
Mailing Address - Fax:586-731-6257
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:SUITE 290
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-314-0080
Practice Address - Fax:586-731-6257
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015127207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5212785Medicaid
MI0E00425OtherBCBSM
MI5212785Medicaid
MI382516038OtherTAX ID NUMBER
MI0F34972Medicare ID - Type UnspecifiedCPC FOR MEDICARE