Provider Demographics
NPI:1093826984
Name:ANDREW J BARKER DO PC
Entity Type:Organization
Organization Name:ANDREW J BARKER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-301-3479
Mailing Address - Street 1:771 KENMOOR AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2370
Mailing Address - Country:US
Mailing Address - Phone:616-301-3479
Mailing Address - Fax:616-301-3508
Practice Address - Street 1:771 KENMOOR AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2370
Practice Address - Country:US
Practice Address - Phone:616-301-3479
Practice Address - Fax:616-301-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015459208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P34530001Medicare PIN
I57196Medicare UPIN